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Objective: EBUS‐TBNA is a method of acquiring tissue samples from intrathoracic lymph nodes and central intrathoracic tumours in patients suspected of having lung cancer. Rapid on‐site evaluation (ROSE) denotes assessing tissue samples during EBUS (or bronchoscopy), providing instant feedback on sample adequacy and provisional cytomorphological diagnosis. Sector multidisciplinary team (MDT) discussion can then make informed treatment decisions, with confirmatory immunohistochemistry being finalised before provision of final treatment. Currently, impact of ROSE on length of time patients spend on the lung cancer diagnostic pathway remains unclear. Methods: We retrospectively evaluated the impact of ROSE on the length of time between patients' EBUS/bronchoscopy procedures and discussion at sector MDT, referred to as time to treatment decision (TTD), at our institution. Additionally, we assessed impact of ROSE on number of passes (number of times nodes/masses were sampled) per procedure. Results: The mean TTD was 77.9% shorter (p = 0.001) with ROSE present than when absent. Patients who received ROSE spend 34.3% less time (p = 0.028) on lung cancer diagnostic pathway overall. There was a significant reduction in number of passes in non‐malignant nodes with ROSE present (2.23) than when absent (3.14) (p < 0.001). With ROSE present there was a significantly greater number of passes at malignant sites (5.07) than non‐malignant sites (2.23) (p < 0.001). Conclusions: These findings support conclusions made in our institution's previous study, that utilisation of ROSE reduces TTD. ROSE also allows safe advancement through nodes with low suspicion of malignant involvement, focusing time on sampling nodes/masses of greater suspicion. [ABSTRACT FROM AUTHOR]

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a standard-of-care modality for evaluating mediastinal lymph nodes and masses. The EBUS bronchoscope may also be introduced through the oesophageal route to perform sampling of accessible lesions, a technique described as transoesophageal bronchoscopic ultrasound-guided fine-needle aspiration (EUS-B-FNA). Because of the central oesophageal approach, EUS-B-FNA provides easy access to the left para-tracheal, subcarinal and para-oesophageal lymph nodes. In addition, the left adrenal gland (LAG) can also be imaged and sampled during the EUS-B-FNA procedure. In patients with suspected lung cancer, accurate staging is essential. Adrenal metastasis is relatively common and may often be a solitary metastatic site. We describe three cases where EUS-B-FNA was performed to safely sample the enlarged LAG in suspected lung cancer. We also review the literature on the performance characteristics of EUS-B-FNA for LAG aspiration. [ABSTRACT FROM AUTHOR]

Lung cancer remains the most common cause of cancer-related deaths in the United States. Traditional treatment of non-small cell lung cancer has included surgical resection for suitable candidates with early stage (I/II) disease and various chemoradiotherapeutic regimens used for advanced disease, for which prognosis has been poor. Since the early 2000s, there has been a revolution in the diagnosis and treatment of non-small cell lung cancer driven by improved diagnostic techniques and therapies targeted to druggable oncogenic drivers or manipulation of the immunologic milieu in the tumor microenvironment. With this has come a need for frequently updated comprehensive data regarding response to treatment and acquired resistance to targeted therapies. In this article, we aim to provide a concise review of the state-of-theart in lung cancer workup in 2021, with a focus on how molecular data now informs treatment decisions. With the burgeoning use of immunotherapeutic approaches, we will also discuss some of the complications seen, and briefly discuss their management. [ABSTRACT FROM AUTHOR]

Aim: The initial mutation status of non-small cell lung cancer (NSCLC) is important for guiding treatment. However, re-biopsy is needed to determine the new mutation status in patients receiving targeted therapy or who develop resistance during first-line therapy. Endobronchial ultrasound (EBUS) is an important tool to obtain adequate tissue for molecular analyses. Materials and Methods: We used a clinical database of 349 patients who were previously included in a multi-center study. Adequacy of tissue collected, new molecular profile, and treatment regimens were evaluated. Results: A total of 50 patients (median age of 60 ± 9 years) received biopsy by EBUS. The success rate was 36% (n = 18), and repeat re-biopsy was performed for patients with anthracosis (n = 32). In 18 patients, only one lymph node station was sampled. Initial histopathology was adenocarcinoma in 28 patients, squamous cell carcinoma (SCC) in 18 patients, and not otherwise specified (NOS) in four patients. No correlation was found between initial treatment type and success rate of the procedure (p = 0.101). After re-biopsy in six patients (five of whom had newly detected mutations), targetable mutations were detected for T790M (n = 2), EGF-Rexon 19 (n = 1), c-Met (n = 1), and EGFR-21 (n = 2). Conclusion: : In cases of resistance to treatment, re-biopsy should be performed to detect different gene amplifications. Re-biopsy with EBUS is an effective method for an appropriate progressive lesion. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Stage classification is important because it allows consistent definition of patient groups, and thus provides a foundation for comparison of outcomes. For patients with multiple pulmonary foci of lung cancer, however, the classification rules are ambiguous and confusing. Materials and methods: We surveyed experts and clinicians who regularly evaluate patients with lung cancer to see how similar or different their interpretation of the official stage classification was for such patients. Results: We found a great deal of inconsistency in how four clinical scenarios were classified. No method of classification was chosen by a majority when there were more than two choices allowed by the classification rules. In a scenario with pulmonary foci of cancer of different histologic types, 86% classified this as separate primary cancers and 14% as multifocal lung cancer. Conclusion: The marked variability in classification must be taken into account when interpreting reported outcomes of patients with multiple pulmonary foci of lung cancer. [Copyright &y& Elsevier]

The current management of non--small cell lung cancer (NSCLC) requires pathological differentiation between adenocarcinoma and squamous cell carcinoma using immunohistochemistry and morphological analysis. Additionally, as novel therapies for specific genetic mutation and chromosomal rearrangement profiles in patients with adenocarcinoma are becoming more numerous and clinically available, adequate tissue acquisition and specimen processing have become crucial. Historically, tissue was obtained via mediastinoscopy or video-assisted thoracoscopy (VATS). However, 80% of patients with lung cancer are ultimately found to be nonsurgical candidates. More recently, endobronchial ultrasound-guided transbronchial needle aspiration (EBUSTBNA) has been shown to be a safe and potentially superior modality to obtain tissue for diagnosis, staging, and molecular profiling. The preparation of tissue specimens has also been the subject of study as differentmethods have been shown to increase cellular yield. This is of particular importance as the number of clinically significant targetable mutations and chromosomal rearrangements continues to grow and the need for more tissue increases. [ABSTRACT FROM AUTHOR]

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Copyright of Archivos de Bronconeumología (English Edition) is the property of Sociedad Espanola de Neumologia y Cirugia Toracica (SEPAR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Radiologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: Conventional transbronchial needle aspiration (TBNA) is a valuable procedure but remains underutilised. Recently, imaging guidance such as CT fluoroscopy has created considerable interest. As CT fluoroscopy is cumbersome and exposes patients and staff to radiation, endosonographic imaging may be a better choice in providing guidance for TBNA or FNA in enlarged mediastinal lymph nodes. Real-time imaging during the procedure is helpful and increases the yield. [Copyright &y& Elsevier]