Adequacy of Samples Obtained by EBUS-TBNA for Molecular Analysis in Patients with Non-Small Cell Lung Cancer: Systematic Review and Meta-Analysis.
Ann Am Thorac Soc. 2018 Jul 16;:
Authors: Labarca G, Folch E, Jantz M, Mehta HJ, Majid A, Fernandez-Bussy S
BACKGROUND: Endobronchial ultrasound and transbronchial needle aspiration (EBUS-TBNA) are commonly used for the diagnosis and mediastinal staging of lung cancer. Molecular markers are becoming increasingly important in patients with lung cancer to define targetable mutations suitable for personalized therapy, such as EGFR, ALK, ROS-1, and PD-L1.
OBJECTIVE: To evaluate the adequacy of EBUS-TBNA derived tissue for molecular analysis.
DATA SOURCES: We searched MEDLINE, Lilacs, clinicaltrials.gov and Epistemonikos through January 2018.
DATA EXTRACTION: Two independent reviewers performed the data search, quality assessment, and data extraction. We included both prospective and retrospective studies; risk of bias was evaluated using the ROBINS-1 tool. The primary outcome was the proportion of adequate samples obtained by EBUS-TBNA for molecular analysis. Data were pooled by using a binary random effects model. Finally, evidence was rated by using the GRADE approach.
SYNTHESIS: A total of 33 studies including 2698 participants were analyzed. In 28 studies that evaluated EBUS-TBNA for the identification of EGFR mutations, the pooled probability of obtaining a sufficient sample was 94.5% (95% Confidence interval (CI), 93.2%-96.4%). For identification of ALK mutations, the pooled probability was 94.9% (95% CI 89.4% – 98.8%). Finally, the prevalence of EGFR mutation was 15.8% (95% CI 12.1%-19.4%), and the prevalence of ALK mutation was 2.77% (95% CI 1.0% – 4.8%). Data for ROS-1 and PD-L1 mutations were not suitable for meta-analysis.
CONCLUSION: EBUS-TBNA has a high yield for molecular analysis of both EGFR and ALK mutations. However, the suitability of TBNA samples for next generation sequencing is uncertain and should be explored in further studies. Study register: PROSPERO CRD42017080008.
PMID: 30011388 [PubMed – as supplied by publisher]