![]() Transbronchial needle aspiration ( tbna) guided by ct images has an established role in the sampling of central adenopathy and masses. Consideration should be given to obtaining up to 6 specimens. Although 4 specimens may be enough to make a diagnosis of lung cancer, they may not provide enough tissue to perform a more detailed molecular analysis. In fact, fewer than half the cases (48%) in the study contained tumour in all biopsy specimens. In addition, not every biopsy contains tumour. 16 found that the mean percentage area of tumour in an endobronchial biopsy sample is 33%. ![]() The amount of tumour contained in the specimens is relatively low. Most bronchoscopists perform bronchial brushing, biopsy, and washing in that order.īiopsy specimens are, in general, small-averaging about 300 malignant cells in aggregate biopsies. ![]() Their study showed that more malignant cells are obtained when bronchial wash is performed after bronchial brushing and bronchial biopsy 15. The optimal sequence of techniques for sampling endobronchial disease has been examined by Chaudhary and colleagues. To optimize specimens, use of a spear forceps that has a small needle between the biopsy jaws to anchor into the airway wall is recommended. When the tumour is located on the lateral wall of the airway, biopsy specimens are difficult to obtain using standard forceps. Historically, 4 specimens have been shown to be adequate for optimal diagnostic yield in central lesions 13, 14. If the lesion in the bronchus is seen, the diagnostic yield for endobronchial biopsy is 70%–90% 12. Lastly, we recount our own experience in obtaining adequate tissue samples in our Rapid Investigation Clinic at McGill University.Įndobronchial tumour. We also discuss the size of the tissue samples obtained by the various techniques, as that size pertains to maximizing the histologic characterization of lung cancer in an era of personalized medicine. In this review, we discuss the minimally invasive and invasive techniques available for the diagnosis and staging of lung cancer, with their success rates and complications. Of nsclc patients receiving chemotherapy for advanced disease, 80% will have only a small biopsy specimen or cytology samples available for diagnosis 8. As a result, biopsy specimens have become increasingly smaller. The goal in this latter group of patients is to establish the diagnosis and, ideally, to confirm the disease stage with the least invasive technique possible. At diagnosis, 75% of patients have either locally advanced or metastatic disease 7. In Canada in 2010, an estimated 25,300 Canadians were diagnosed with lung cancer, and 20,600 died of the disease 6. Lung cancer remains the leading cause of cancer death in North America. Those mutations are found almost exclusively in adenocarcinomas. Ongoing clinical trials are examining the use of Alk inhibitors in patients with nsclc characterized by EML4–ALK gene translocations 5. Trials using tyrosine kinase inhibitors have observed that greater benefit from treatment with those agents is seen in patients with nsclc tumours harbouring EGFR mutations than in patients with wild-type tumours 4. For example, several trials have shown that response rate and survival with pemetrexed are significantly better in patients with non-squamous histology 1 – 3. The observation that certain histologic subtypes respond differently to particular chemotherapeutic agents and the increasing use of targeted therapies have created a need for precise histologic characterization of biopsy specimens. In recent years, the histologic characterization of lung cancer has markedly advanced, moving beyond the simple distinction of small-cell or non-small-cell disease. ![]() Discoveries in molecular biology are changing the approach to the treatment of patients with non-small-cell lung cancer ( nsclc).
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