Adequacy of Lymph Node Transbronchial Needle Aspirates Using Convex Probe Endobronchial Ultrasound for Multiple Tumor Genotyping Techniques in Non–Small-Cell.

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Adequacy of Lymph Node Transbronchial Needle Aspirates Using Convex Probe Endobronchial Ultrasound for Multiple Tumor Genotyping Techniques in Non–Small-Cell Lung Cancer Erik Folch, MD, MSc, Norihiro Yamaguchi, MD, MPH, Paul A. VanderLaan, MD, PhD, Olivier N. Kocher, MD, PhD, David H. Boucher, BS, Michael A. Goldstein, MD, Mark S. Huberman, MD, Michael S. Kent, MD, Sidharta P. Gangadharan, MD, Daniel B. Costa, MD, PhD, Adnan Majid, MD Journal of Thoracic Oncology Volume 8, Issue 11, Pages 1438-1444 (November 2013) DOI: 10.1097/JTO.0b013e3182a471a9 Copyright © 2013 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 1 Histopathology of different minimally invasive methods for thoracic tissue sampling. A and B, Image-guided percutaneous transthoracic core-needle biopsies from a left upper lobe lung mass. The low-power field highlights one of two needle core biopsies obtained, both demonstrating significant fibrosis with intervening areas of invasive adenocarcinoma. On higher power, the tumor cells demonstrate a glandular structure, with associated chronic inflammation. Cytologic rapid on-site evaluation of touch prep slides from the core biopsies confirmed adenocarcinoma, and subsequent tumor genotyping successfully identified a deletion mutation in exon 19 of the EGFR gene. C and D, Bronchoscopy-guided lung biopsies of a right middle lobe lung mass. The low-power field in (C) shows two of the six airway tissue biopsies obtained. The higher-power view demonstrates a poorly differentiated adenocarcinoma with cytoplasmic mucin vacuoles infiltrating submucosal lymphatic spaces, with surrounding bronchial associated lymphoid tissue and overlying respiratory epithelium. Tumor genotyping successfully identified a mutation in exon 20 of the EGFR gene. E and F, Cell block preparation from a convex probe endobronchial ultrasound transbronchial needle aspiration of mediastinal lymph nodes. The low-power field view in (E), covering approximately 25% of the cell block area, highlights the cellular specimen with numerous clusters of tumor cells in a background of eosinophilic fibrin clot. On higher power the background lymphocytes confirm lymph node sampling, and the tumor structure is that of a moderately differentiated adenocarcinoma. Tumor genotyping was successful. A, C, and E, ×40 original magnification; B, D, and F, ×200 original magnification representing boxed area in prior panel; hematoxylin and eosin stains. EGFR, epidermal growth factor receptor. Journal of Thoracic Oncology 2013 8, 1438-1444DOI: (10.1097/JTO.0b013e3182a471a9) Copyright © 2013 International Association for the Study of Lung Cancer Terms and Conditions