More challenging than ever: Getting adequate lung cancer tissue for histologic and molecular analysis using finer and finer biopsy methods

http://www.ncbi.nlm.nih.gov/pubmed/21178716

J Thorac Oncol. 2011 Jan;6(1):203-206.
How I Do It-Optimal Methodology for Multidirectional Analysis of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Samples.
Nakajima T, Yasufuku K.

Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive modality with a high diagnostic yield for mediastinal lymph node staging of patients with lung cancer. Although limited to the use of needle aspiration during EBUS-TBNA, aspirates has been shown to be useful for molecular analysis. However, the ideal methodology of the specimen handling during EBUS-TBNA has not been described.

METHODS: Based on our institutional experience and review of the literature, we describe the optimal methodology for multidirectional analysis of EBUS-TBNA samples.

RESULTS: EBUS-TBNA specimens can be used for molecular analysis such as epidermal growth factor receptor (EGFR), Anaplastic lymphoma kinase (ALK) and V-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog (KRAS) mutations when processed properly. Rapid on-site cytology is invaluable during the assessment of the aspirated during EBUS-TBNA.

DISCUSSION: Obtaining adequate samples through a non-surgical biopsy technique for pathologic diagnosis as well as molecular analysis will be of immediate importance for personalized management of lung cancer. EBUS-TBNA is an ideal approach that allows combined pathological and molecular analysis of metastatic lymph nodes.