Advances in Lung Biopsies Ensure Reliability of Biomarker Testing

Abhinav Agrawal, MD, system director of interventional pulmonology at Northwell Health in New York, discusses findings from a multidisciplinary expert panel on endoscopic lung and lymph node biopsies that show how changes in biopsy methods have affected comprehensive biomarker testing in lung cancer.

According to Agrawal, the traditional method of mediastinoscopy was used for diagnosing and staging lung cancer, but now endobronchial ultrasound (EBUS)-guided biopsy of lymph nodes is largely used. EBUS-guided biopsy has an established safety benefit vs mediastinoscopy due less invasiveness and reduced complications such as pneumothorax. Based on a review of many studies, they concluded that in addition to this, the sample yield for diagnostics and biomarker testing was comparable to mediastinoscopy.

Agrawal points to advanced tools now being used as part of endoscopy such as cryoprobes that can freeze and extract a larger sample, which have further improved outcomes and reduced the need for repeat biopsy. This supports EBUS being used over mediastinoscopy in most scenarios for patients with suspected lung cancer or to get tissue samples for comprehensive molecular testing.

TRANSCRIPTION

0:08 | When we are doing mediastinal or hilar lymph node biopsy using endobronchial ultrasound, the traditional way about 20 years ago was mediastinoscopy, when EBUS was not available. The community has seen a shift to doing EBUS-guided lymph node biopsy given the high sensitivity, as well as the high positive predictive value and negative predictive value. What we tried to answer was to compare that with mediastinoscopy in terms of safety, which I think is well established. Our data reaffirmed that it is a safer procedure because it is less invasive.

0:40 | But in terms of molecular and diagnostic yield, despite being less invasive, as we have advanced our tools, both in terms of different needles as well as the ability to do a mediastinal cryobiopsy using a cryoprobe, and therefore freezing and taking a larger piece, the biomarker testing is comparable. Unless there are some scenarios where a mediastinoscopy is needed, the EBUS-guided lymph node biopsy is the first approach for patients either with suspected lung cancer or patients for whom a biopsy is needed to obtain additional tissue for molecular testing.