Abstract
The role of bronchoscopic brushing for tumor detection and molecular testing in central lung cancer is unclear. In this study, 50 consecutive subjects with suspected central lung cancer underwent bronchoscopic brushing (31 males, median age 70, 5 never smokers). Histological results were: NSCLC/SCLC/low-grade-NET/granulation tissue in 36/8/2/4 cases. Next generation sequencing (NGS) was feasible in 62% of tumor-positive brush smear samples. In 78% of these cases, NGS displayed identical results compared to histology samples, in 22% NGS from brush smears detected specific mutations, whereas DNA quality from forceps biopsy was insufficient for NGS analysis. Sensitivity, specificity, positive predictive value, negative predictive value of brush smear analysis were 66% (95% confidence interval 50–79), 100% (40–100), 100% (85–100), and 21% (7–46). For the combined analysis of brush smear, brush tip washing and sheath tube content sensitivity was slightly elevated at 69% (53–81). In central lung cancer, bronchoscopic brushing detects tumor cells in about two-third of cases and allows a decision for or against targeted therapy in the majority of tumor-positive cases on the basis of NGS analysis.
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Abbreviations
- ALK:
-
Anaplastic lymphoma kinase
- c.:
-
Coding deoxyribonucleotide acid sequence (mutation at nucleotide level)
- DDR2:
-
Discoidin domain receptor 2
- EBUS-TBNA:
-
Endobronchial ultrasound-guided transbronchial needle aspiration
- KRAS:
-
Kirsten rat sarcoma viral oncogene homolog
- MET:
-
Mesenchymal-epidermal transition proto-oncogene
- NET:
-
Neuroendocrine tumor
- NGS:
-
Next generation sequencing
- NRAS:
-
Neuroblastoma RAS viral oncogene homolog
- NSCLC:
-
Non-small cell lung cancer
- NPV:
-
Negative predictive value
- p.:
-
Protein (change at amino acid level)
- PIK3CA:
-
Phosphatidylinositol-4,5-bisphosphate 3-kinase, catalytic subunit alpha
- PPV:
-
Positive predictive value
- PTEN:
-
Phosphatase and tensin homolog
- RET:
-
Rearranged during transfection proto-oncogene
- ROS1:
-
ROS1 proto-oncogene
- SCLC:
-
Small cell lung cancer
- TP53:
-
Tumor protein 53
- TTF1:
-
Thyroid transcription factor 1
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Lars Hagmeyer, Jana Fassunke, Marianne Engels, Marcel Treml, Simon Herkenrath, Sandhya Matthes, Reinhard Büttner, Winfried Randerath states that they have no conflict of interest.
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Hagmeyer, L., Fassunke, J., Engels, M. et al. Bronchoscopic Brushing from Central Lung Cancer—Next Generation Sequencing Results are Reliable. Lung 197, 333–337 (2019). https://doi.org/10.1007/s00408-019-00213-8
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DOI: https://doi.org/10.1007/s00408-019-00213-8