Diagnostic Accuracy of Slow-Capillary Endobronchial Ultrasound Needle Aspiration in Determining PD-L1 Expression in Non-Small Cell Lung Cancer

HIGHLIGHTS: What are the main findings? Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) with slow-pull capillary aspiration has been found to be an accurate tool to obtain adequate samples for PD-L1 evaluation in patients with non-small cells lung cancer (NSCLC) and mediastinal lymphadenopathies. What is the implication of the main finding? EBUS-TBNA with no-suction technique (e.g., slow-pull capillary aspiration) can be used not only to get a definite diagnosis of lung cancer in patients with mediastinal lymphadenopathies but also to assess PD-L1 expression and, consequently, to guide treatment decisions (i.e., whether use immunotherapy) in patients with NSCLC. ABSTRACT: Introduction: The role of EBUS-TBNA in the diagnosis and staging of lung cancer is well established. EBUS-TBNA can be performed using different aspiration techniques. The most common aspiration technique is known as “suction”. One alternative to the suction technique is the slow-pull capillary aspiration. To the best of our knowledge, no studies have assessed the diagnostic yield of slow-pull capillary EBUS-TBNA in PD-L1 amplification assessment in NSCLC. Herein, we conducted a single-centre retrospective study to establish the diagnostic yield of slow-pull capillary EBUS-TBNA in terms of PD-L1 in patients with NSCLC and hilar/mediastinal lymphadenopathies subsequent to NSCLC. Materials and Methods: Patients with hilar and/or mediastinal lymph node (LN) NSCLC metastasis, diagnosed by EBUS-TBNA between January 2021 and April 2022 at Pulmonology Unit of “Ospedali Riuniti di Ancona” (Ancona, Italy) were enrolled. We evaluated patient characteristics, including demographic information, CT scan/ FDG-PET features and final histological diagnoses, including PD-L1 assessment. Results: A total of 174 patients underwent EBUS-TBNA for diagnosis of hilar/mediastinal lymphadenopathies between January 2021 and April 2022 in the Interventional Pulmonology Unit of the “Ospedali Riuniti di Ancona”. Slow-pull capillary aspiration was adopted in 60 patients (34.5%), and in 30/60 patients (50.0%) NSCLC was diagnosed. EBUS-TBNA with slow-pull capillary aspiration provided adequate sampling for molecular biology and PD-L1 testing in 96.7% of patients (29/30); in 15/29 (51.7%) samples with more than 1000 viable cells/HPF were identified, whereas in 14/29 (48.3%) samples contained 101–1000 viable cells/HPF. Conclusion: These retrospective study shows that slow-pull capillary aspiration carries an excellent diagnostic accuracy, almost equal to that one reported in literature, supporting its use in EBUS-TBNA for PD-L1 testing in NSCLC.