Endobronchial Ultrasound Guided Transbronchial Needle Aspiration and PD-L1 Yields

Lara M Khoury; Kristin N Sheehan; William I Mariencheck; Katherine A Gershner; Matthew Maslonka; Angela G Niehaus; Scott Isom; Christina R Bellinger

doi:10.1007/s00408-024-00692-4

Endobronchial Ultrasound Guided Transbronchial Needle Aspiration and PD-L1 Yields

Lung. 2024 Apr 18. doi: 10.1007/s00408-024-00692-4. Online ahead of print.

Authors

Lara M Khoury¹, Kristin N Sheehan², William I Mariencheck², Katherine A Gershner², Matthew Maslonka³, Angela G Niehaus⁴, Scott Isom⁵, Christina R Bellinger²

Affiliations

¹ Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA. lkhoury@wakehealth.edu.
² Department of Pulmonary and Critical Care Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
³ Department of Pulmonary and Critical Care Medicine, Nebraska Pulmonary Specialties, Lincoln, NE, USA.
⁴ Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
⁵ Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA.

PMID: 38637361
DOI: 10.1007/s00408-024-00692-4

Abstract

Purpose: Immunotherapy is a leading approach for treating advanced non-small cell lung cancer (NSCLC) by targeting the PD-1/PD-L1 checkpoint signaling pathway, particularly in tumors expressing high levels of PD-L1 (Jug et al. in J Am Soc Cytopathol 9:485-493, 2020; Perrotta et al. in Chest 158: 1230-1239, 2020). Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive method to obtain tissue for molecular studies, including PD-L1 analysis, in unresectable tumors (Genova et al. in Front Immunol 12: 799455, 2021; Wang et al. in Ann Oncol 29: 1417-1422, 2018). This study aimed to assess the adequacy of PD-L1 assessment in EBUS-TBNA cytology specimens.

Methods: Data was collected retrospectively from patients who underwent EBUS-TBNA between 2017 and 2021 for suspected lung cancer biopsy. Samples positive for NSCLC were examined for PD-L1 expression. EBUS was performed by experienced practitioners, following institutional guidelines of a minimum of five aspirations from positively identified lesions. Sample adequacy for molecular testing was determined by the pathology department.

Results: The analysis involved 387 NSCLC cases (149 squamous cell, 191 adenocarcinoma, 47 unspecified). Of the 263 EBUS-TBNA specimens tested for PD-L1, 237 (90.1%) were deemed adequate. While 84% adhered to the protocol, adherence did not yield better results. Significantly higher PD-L1 adequacy was observed in squamous cell carcinomas (93.2%) compared to adenocarcinoma (87.6%). The number of aspirations and sedation type did not correlate with PD-L1 adequacy in either cancer type, but lesion size and location had a significant impact in adenocarcinomas. Adenocarcinoma exhibited higher PD-L1 expression (68%) compared to squamous cell carcinoma (48%).

Conclusion: EBUS-TBNA offers high yields for assessing immunotherapy markers like PD-L1, with satisfactory adequacy regardless of NSCLC subtype, lesion size, or location.

Keywords: Bronchoscopy; EBUS-TBNA; Lung cancer; Molecular markers; PD-L1 yields.