Patients with lung cancer may undergo endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) a technique used to diagnose and stage cancer, in which an imaging scope is inserted into the lungs, allowing clinicians to visualize the airways and sample tissues. EBUS-TBNA can also be used for molecular profiling of lung cancer, which would play an important role in selecting treatment options for these patients. To demonstrate that EBUS-TBNA can be used for both pathological and genotyping analyses, Trisolini et al. studied the effectiveness of rapid on-site evaluation (ROSE) in patients with nonsquamous non–small cell lung cancer.
Adults known or suspected to have advanced lung cancer were randomized to undergo EBUS-TBNA with or without ROSE. The authors were primarily interested in the rate of success in achieving the institution’s clinical protocol for genotyping of lung cancer but also evaluated sensitivity and adequacy of EBUS-TBNA. Patients without ROSE underwent the standard minimum of three needle passes at bronchoscopy, whereas in the ROSE cohort, the pathologist analyzed samples after each needle pass and informed the pulmonologist once enough sample had been obtained. Bidirectional next-generation sequencing was performed on the lung tissue samples to look for EGFR and KRAS mutations. Fluorescence in situ hybridization was used to detect ALK gene rearrangement.
Malignancy was detected in 163 of 197 patients who participated in the study. Compared with EBUS-TBNA alone, EBUS-TBNA with ROSE prevented unnecessary, invasive bronchoscopy procedures in 1 out of 10 patients by drawing diagnostic conclusions after sampling a single site. Use of ROSE also resulted in a higher percentage of patients meeting the institution’s clinical protocol for complete genotyping of their lung cancer. At this time, the extrapolation of these results to other fields is unclear, as this study was performed by highly experienced interventional pulmonologists at a single institution, but the data do suggest that ROSE could improve patient quality of care by avoiding excessive intervention.
