title: Suitability of endobronchial ultrasound-guided transbronchial needle aspiration specimens for subtyping and genotyping of non-small cell lung cancer: a multicenter study of 774 patients.
abstract: BACKGROUND
  The current management of advanced non-small cell lung cancer (NSCLC) requires differentiation between squamous and nonsquamous subtypes as well as epidermal growth factor receptor (EGFR) mutation status. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is increasingly used for the diagnosis and staging of lung cancer. However, it is unclear whether cytology specimens obtained with EBUS-TBNA are suitable for the subclassification and genotyping of NSCLC.
  
  
  OBJECTIVE
  To determine whether cytology specimens obtained from EBUS-TBNA in routine practice are suitable for phenotyping and genotyping of NSCLC.
  
  
  METHODS
  Cytological diagnoses from EBUS-TBNA were recorded from 774 patients with known or suspected lung cancer across five centers in the United Kingdom between 2009 and 2011.
  
  
  RESULTS
  The proportion of patients with a final diagnosis by EBUS-TBNA in whom subtype was classified was 77% (95% confidence interval [CI], 73-80). The rate of NSCLC not otherwise specified (NSCLC-NOS) was significantly reduced in patients who underwent immunohistochemistry (adjusted odds ratio, 0.50; 95% CI, 0.28-0.82; P = 0.016). EGFR mutation analysis was possible in 107 (90%) of the 119 patients in whom mutation analysis was requested. The sensitivity, negative predictive value, and diagnostic accuracy of EBUS-TBNA in patients with NSCLC were 88% (95% CI, 86-91), 72% (95% CI, 66-77), and 91% (95% CI, 89-93), respectively.
  
  
  CONCLUSIONS
  This large, multicenter, pragmatic study demonstrates that cytology samples obtained from EBUS-TBNA in routine practice are suitable for subtyping of NSCLC and EGFR mutation analysis and that the use of immunohistochemistry reduces the rate of NSCLC-NOS.
authors.affiliation: The Centre for Lung Carcinogenesis and Regeneration, University College London, London, United Kingdom. neal.navani@uclh.nhs.uk
authors.forename: Neal
authors.initials: N
authors.lastname: Navani
authors.forename: James M
authors.initials: JM
authors.lastname: Brown
authors.forename: Matthew
authors.initials: M
authors.lastname: Nankivell
authors.forename: Ian
authors.initials: I
authors.lastname: Woolhouse
authors.forename: Richard N
authors.initials: RN
authors.lastname: Harrison
authors.forename: Vandana
authors.initials: V
authors.lastname: Jeebun
authors.forename: Mohammed
authors.initials: M
authors.lastname: Munavvar
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Ng
authors.forename: Doris M
authors.initials: DM
authors.lastname: Rassl
authors.forename: Mary
authors.initials: M
authors.lastname: Falzon
authors.forename: Gabrijela
authors.initials: G
authors.lastname: Kocjan
authors.forename: Robert C
authors.initials: RC
authors.lastname: Rintoul
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Nicholson
authors.forename: Sam M
authors.initials: SM
authors.lastname: Janes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D044963:Biopsy, Fine-Needle; D001999:Bronchoscopy / Q000379:methods; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000235:genetics / Q000401:mortality / Q000473:pathology*; D015331:Cohort Studies; D016001:Confidence Intervals; D003581:Cytodiagnosis / Q000379:methods; D019160:Endosonography / Q000379:methods*; D005260:Female; D005838:Genotype; D006801:Humans; D007150:Immunohistochemistry; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000235:genetics / Q000401:mortality / Q000473:pathology*; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D016017:Odds Ratio; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D006113:United Kingdom