Only EBUS-Guided Mediastinal Lymph Node Cryobiopsy Enabled Immunotherapy in a Patient with Non-Small Cell Lung Cancer

Personalized treatment of metastatic non-squamous non-small cell lung cancer (NSCLC) requires detailed molecular characterization of the tumour including detection of predictive driver mutations and programmed death ligand 1 (PD-L1) expression. Complete detection is influenced by the amount of tumou...

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Published inJournal of clinical medicine Vol. 12; no. 6; p. 2355
Main Authors Hetzel, Jürgen, Mauti, Laetitia A, Winkler, Jonas, Cardoso Almeida, Sabine, Jermann, Philip, Pless, Miklos, Bubendorf, Lukas, Bode, Peter Karl, Häntschel, Maik
Format Journal Article
LanguageEnglish
Published Switzerland MDPI AG 17.03.2023
MDPI
Subjects
Biopsy
Cancer therapies
Care and treatment
Case studies
Chemotherapy
Clinical medicine
Communication
Conflicts of interest
Cryosurgery
Diagnosis
Endoscopy
Immunotherapy
Ligands
Lung cancer
Lung cancer, Non-small cell
Lymph nodes
Lymphatic system
Mediastinal tumors
Metastasis
Mutation
Patients
Pleural effusion
Germany
Basel Switzerland
Switzerland
lung cancer
cryobiopsy
mediastinal lymph node biopsy
NSCLC
bronchoscopy
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Summary:Personalized treatment of metastatic non-squamous non-small cell lung cancer (NSCLC) requires detailed molecular characterization of the tumour including detection of predictive driver mutations and programmed death ligand 1 (PD-L1) expression. Complete detection is influenced by the amount of tumour cells sampled as well as their quality. Different sampling techniques may be necessary to provide sufficient tumour material for comprehensive molecular characterization. Missing the detection of targetable molecular genetic aberrations would have a serious impact on the quality of life and prognosis of a patient. This case report highlights the importance of biopsy technique in a patient with NSCLC. Several procedures-pleural puncture, transthoracic lung biopsy and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA)-could not provide sufficient tumour material for precise tumour characterization. Only the addition of EBUS-guided transbronchial lymph node cryobiopsy (EBUS-TBLNC) enabled complete immunohistochemical and genetic tumour characterization, demonstrating PD-L1 expression in 100% of the tumour cells in the absence of actionable genetic alterations. Based on these results, immunotherapy was initiated.
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These authors contributed equally to this work.
ISSN:2077-0383
2077-0383
DOI:10.3390/jcm12062355