Purpose
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is widely used for the diagnosis and staging of lung cancer. However, evidence of its usefulness for re-biopsy in treated lung cancer, especially according to the previous treatment, is limited. We evaluated the role of EBUS-TBNA for re-biopsy and its diagnostic values in patients with different treatment histories.
Materials and Methods
We reviewed the medical records of patients who underwent EBUS-TBNA for re-biopsy of suspicious recurrent or progressive lesions between January 2006 and December 2016 at the National Cancer Center in South Korea. Patients were categorized into three groups based on the previous treatment modalities: surgery, radiation, and palliation.
Results
Among the 367 patients (surgery, n=192; radiation, n=40; palliation, n=135) who underwent EBUS-TBNA for re-biopsy, the overall sensitivity, negative predictive value (NPV), and diagnostic accuracy of EBUS-TBNA in detecting malignancy were 95.6%, 82.7%, and 96.3%, respectively. The sensitivity was lower in the radiation group (83.3%) when compared with the surgery (95.7%, p=0.042) and palliation (97.7%, p=0.012) groups. The NPV was lower in the palliation group (50.0%) than in the surgery group (88.5%, p=0.042). The sample adequacy of EBUS-TBNA specimens was lower in the radiation group (80.3%) than in the surgery (95.4%, p < 0.001) or palliation (97.8%, p < 0.001) groups. EGFR mutation analysis was feasible in 94.6% of the 92 cases, in which mutation analysis was requested. There were no major complications. Minor complications were reported in 12 patients (3.3%).
Conclusion
EBUS-TBNA showed high diagnostic values and high suitability for EGFR mutation analysis with regard to re-biopsy in patients with previously treated lung cancer. The sensitivity was lower in the radiation group and NPV was lower in the palliation group. The complication rate was low.
Citations
Citations to this article as recorded by
Repeat biopsy versus initial biopsy in terms of complication risk factors and clinical outcomes for patients with non-small cell lung cancer: a comparative study of 113 CT-guided needle biopsy of lung lesions Yangyang Wang, Yongyuan Zhang, Nana Ren, Fangting Li, Lin Lu, Xin Zhao, Zhigang Zhou, Mengyu Gao, Meng Wang Frontiers in Oncology.2024;[Epub] CrossRef
Artificial Intelligence Algorithm Can Predict Lymph Node Malignancy from Endobronchial Ultrasound Transbronchial Needle Aspiration Images for Non-Small Cell Lung Cancer Yogita S. Patel, Anthony A. Gatti, Forough Farrokhyar, Feng Xie, Waël C. Hanna Respiration.2024; : 1. CrossRef
Place de l’endoscopie dans l’exploration du médiastin, indications et résultats F. Wallyn, C. Fournier, V. Jounieaux, D. Basille Revue des Maladies Respiratoires.2023; 40(1): 78. CrossRef
Prognostic Impact of EBUS TBNA for Lung Adenocarcinoma Patients with Postoperative Recurrences Ying-Yi Chen, Ying-Shian Chen, Tsai-Wang Huang Diagnostics.2022; 12(10): 2547. CrossRef
Endobronchial ultrasound-guided transbronchial needle aspiration in patients with previously treated malignancies: diagnostic performance and predictive value Yan Yan, Zhilong Wang, Wanpu Yan, Shijie Li, Qi Wu BMC Pulmonary Medicine.2022;[Epub] CrossRef
The Feasibility of Interventional Pulmonology Methods for Detecting the T790M Mutation after the First or Second-Generation EGFR-TKI Resistance of Non-Small Cell Lung Cancer Wen-Chien Cheng, Yi-Cheng Shen, Chieh-Lung Chen, Wei-Chih Liao, Hung-Jen Chen, Te-Chun Hsia, Chia-Hung Chen, Chih-Yen Tu Diagnostics.2022; 13(1): 129. CrossRef
Impact of EBUS-TBNA in addition to [18F]FDG-PET/CT imaging on target volume definition for radiochemotherapy in stage III NSCLC Maja Guberina, Kaid Darwiche, Hubertus Hautzel, Till Ploenes, Christoph Pöttgen, Nika Guberina, Ken Herrmann, Lale Umutlu, Axel Wetter, Dirk Theegarten, Clemens Aigner, Wilfried Ernst Erich Eberhardt, Martin Schuler, Rüdiger Karpf-Wissel, Martin Stuschke European Journal of Nuclear Medicine and Molecular Imaging.2021; 48(9): 2894. CrossRef
Tissue Adequacy and Safety of Percutaneous Transthoracic Needle Biopsy for Molecular Analysis in Non-Small Cell Lung Cancer: A Systematic Review and Meta-analysis Bo Da Nam, Soon Ho Yoon, Hyunsook Hong, Jung Hwa Hwang, Jin Mo Goo, Suyeon Park Korean Journal of Radiology.2021; 22(12): 2082. CrossRef
Purpose
Because of growing concerns about lung cancer in female never smokers, chest low-dose computed tomography (LDCT) screening is often performed although it has never shown clinical benefits. We examinewhether or not female never smokers really need annual LDCT screening when the initial LDCT showed negative findings.
Materials and Methods
This retrospective cohort study included 4,365 female never smokers aged 40 to 79 years who performed initial LDCT from Aug 2002 to Dec 2007. Lung cancer diagnosis was identified from the Korea Central Cancer Registry Database registered until December 31, 2013. We calculated the incidence, cumulative probability, and standardized incidence ratio (SIR) of lung cancer by Lung Imaging Reporting and Data System (Lung-RADS) categories showed on initial LDCT.
Results
After median follow-up of 9.69 years, 22 (0.5%) had lung cancer. Lung cancer incidence for Lung-RADS category 4 was 1,848.4 (95% confidence interval [CI], 1,132.4 to 3,017.2) per 100,000 person-years and 16.4 (95% CI, 7.4 to 36.4) for categories 1, 2, and 3 combined. The cumulative probability of lung cancer for category 4 was 10.6% at 5 years and 14.8% at 10 years while they were 0.07% and 0.17% when categories 1, 2, and 3 were combined. The SIR for subjects with category 4 was 43.80 (95% CI, 25.03 to 71.14), which was much higher than 0.47 (95% CI, 0.17 to 1.02) for categories 1, 2, and 3 combined.
Conclusion
Considering the low risk of lung cancer development in female never smokers, it seems unnecessary to repeat annual LDCT screening for at least 5 years or even longer unless the initial LDCT showed Lung-RADS category 4 findings.
Citations
Citations to this article as recorded by
Lung cancer screening for never smokers: current evidence and future directions Kay Choong See Singapore Medical Journal.2024;[Epub] CrossRef
Cooking oil fume exposure and Lung-RADS distribution among school cafeteria workers of South Korea Minjun Kim, Yangho Kim, A Ram Kim, Woon Jung Kwon, Soyeoun Lim, Woojin Kim, Cheolin Yoo Annals of Occupational and Environmental Medicine.2024;[Epub] CrossRef
Distribution of Solid Lung Nodules Presence and Size by Age and Sex in a Northern European Nonsmoking Population Jiali Cai, Marleen Vonder, Gert Jan Pelgrim, Mieneke Rook, Gerdien Kramer, Harry J.M. Groen, Geertruida H. de Bock, Rozemarijn Vliegenthart Radiology.2024;[Epub] CrossRef
Low Dose Computed Tomography for Lung Cancer Screening in Tuberculosis Endemic Countries: A Systematic Review and Meta-Analysis Vikram Damaraju, Juhu Kiran Krushna Karri, Gayathri Gandrakota, Yamini Marimuthu, Adimulam Ganga Ravindra, Rajeev Aravindakshan, Navneet Singh Journal of Thoracic Oncology.2024;[Epub] CrossRef
Toward More Effective Lung Cancer Risk Stratification to Empower Screening Programs for the Asian Nonsmoking Population Fu-Zong Wu, Yeun-Chung Chang Journal of the American College of Radiology.2023; 20(2): 156. CrossRef
ACR Appropriateness Criteria® Lung Cancer Screening: 2022 Update Kim L. Sandler, Travis S. Henry, Arya Amini, Saeed Elojeimy, Aine Marie Kelly, Christopher T. Kuzniewski, Elizabeth Lee, Maria D. Martin, Michael F. Morris, Neeraja B. Peterson, Constantine A. Raptis, Gerard A. Silvestri, Arlene Sirajuddin, Betty C. Tong, Journal of the American College of Radiology.2023; 20(5): S94. CrossRef
Performance of Lung-RADS in different target populations: a systematic review and meta-analysis Yifei Mao, Jiali Cai, Marjolein A. Heuvelmans, Rozemarijn Vliegenthart, Harry J. M. Groen, Matthijs Oudkerk, Marleen Vonder, Monique D. Dorrius, Geertruida H. de Bock European Radiology.2023; 34(3): 1877. CrossRef
Lung cancer screening in never-smokers: facts and remaining issues Maurizio V. Infante, Giuseppe Cardillo European Respiratory Journal.2020; 56(5): 2002949. CrossRef
Low-dose chest computed tomographic screening and invasive diagnosis of pulmonary nodules for lung cancer in never-smokers Yeon Wook Kim, Hye-Rin Kang, Byoung Soo Kwon, Sung Yoon Lim, Yeon Joo Lee, Jong Sun Park, Young-Jae Cho, Ho Il Yoon, Kyung Won Lee, Jae Ho Lee, Choon-Taek Lee European Respiratory Journal.2020; 56(5): 2000177. CrossRef
Predicting Lung Cancer Occurrence in Never-Smoking Females in Asia: TNSF-SQ, a Prediction Model Li-Hsin Chien, Chung-Hsing Chen, Tzu-Yu Chen, Gee-Chen Chang, Ying-Huang Tsai, Chin-Fu Hsiao, Kuan-Yu Chen, Wu-Chou Su, Wen-Chang Wang, Ming-Shyan Huang, Yuh-Min Chen, Chih-Yi Chen, Sheng-Kai Liang, Chung-Yu Chen, Chih-Liang Wang, Mei-Hsuan Lee, Ren-Hua C Cancer Epidemiology, Biomarkers & Prevention.2020; 29(2): 452. CrossRef
Role of Low-Dose Computerized Tomography in Lung Cancer Screening among Never-Smokers Hye-Rin Kang, Jun Yeun Cho, Sang Hoon Lee, Yeon Joo Lee, Jong Sun Park, Young-Jae Cho, Ho Il Yoon, Kyung Won Lee, Jae Ho Lee, Choon-Taek Lee Journal of Thoracic Oncology.2019; 14(3): 436. CrossRef
Prevention and Early Detection for NSCLC: Advances in Thoracic Oncology 2018 Haval Balata, Kwun M. Fong, Lizza E. Hendriks, Stephen Lam, Jamie S. Ostroff, Nir Peled, Ning Wu, Charu Aggarwal Journal of Thoracic Oncology.2019; 14(9): 1513. CrossRef