A usefulness of 25G core needles for immunohistochemistry and molecular testing in lung cancer patients – a feasibility study

Abstract

Introduction: A majority of advanced lung cancer (LC) patients should be considered for targeted oncological treatment. CT/PET-CT and EBUS/EUS-b-NA with use of 22G cytological needles are standard staging procedures. Little is known about efficacy of histological core needles to obtain a sufficient material for immunohistochemistry (IHC) and molecular testing (MT). Aims: To evaluate efficacy of EBUS/EUS-b-NA using histological 25G core needles in LC patients stage IIIB/IV. Methods: Consecutive patients with confirmed or suspected advanced LC were included into a single center prospective observational trial. Endosonography was performed with use of 25G core needles. If biopsy was positive for LC material was sent for IHC and MT. If biopsy was negative then repeated with use of standard 22G cytological needles. Results: Since January to February 2019 – 20 patients (M:13, F:7) of mean age (SD) 68 (6.4) years underwent endosonography. A histology was conclusive in 18/20 patients: SCLC – 8, Adenocarcinoma – 6, Squamous-Cell Carcinoma (SCC) – 3, Not otherwise specified (NOS) – 1. In all group sensitivity, accuracy and PPV for histology and IHC tests was (90%, 100%, 100%). In 2 FN patients, in whom undifferentiated cancer cells were only found, EBUS-NA with use of 22G needle confirmed SCLC – 1 and SCC – 1. In 9/11 of NSCLC patients sensitivity, accuracy and PPV for endosonography with use of 25G core needles for MT was (81.8%, 100%, 100%). No complications after biopsies were observed. Conclusions: The endosonography with use of histological 25G core needles is feasible and safe and seems to be a reasonable approach for IHC and MT in advanced LC patients