Guideline Panel: Bronchoscopic Lung-Biopsy Techniques Comparable to Percutaneous Approaches for Biomarker Testing

Guided-bronchoscopy sampling “provides tissue of comparable adequacy” to percutaneous CT-guided biopsy for comprehensive biomarker testing, according to a multidisciplinary guideline panel convened by the American Association of Bronchology and Interventional Pulmonology (AABIP) and the Early Detection & Screening Committee of the International Association for the Study of Lung Cancer (IASLC).

In addition, the guideline panel determined that guided-bronchoscopy sampling delivers a “superior safety profile—especially when contemporary navigational technologies are employed,” according to an IASLC announcement on the updated guidelines.

The clinical practice guidelines developed by AABIP and IASLC “provide evidence on the safety and sampling adequacy for comprehensive biomarker testing of bronchoscopy-guided lung parenchymal biopsies as compared to percutaneous biopsies, and endobronchial ultrasound-guided lymph node sampling as compared to mediastinoscopy,” officials said in the announcement. The authors published the guidelines in the Journal of Thoracic Oncology, the official journal of IASLC.

Abhinav Agrawal, MD, System Director of Interventional Pulmonology and Associate Professor of Medicine & Cardiovascular/Thoracic Surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, weighed in on the updated guidelines in a statement provided by IASLC.

“These recommendations are immediately actionable for clinicians deciding how best to obtain tissue for biomarker analysis in suspected or confirmed lung cancer,” Dr. Agrawal said. “They should also inform the design of future clinical trials by highlighting both sample adequacy and the safety advantages of minimally invasive bronchoscopic techniques when compared with percutaneous approaches.”

IASLC officials outlined the key findings of the multidisciplinary guideline panel:

• Sampling adequacy: Across the analyzed studies, bronchoscopy-guided parenchymal biopsies “yielded molecular-testing specimens equivalent in quality and quantity to those obtained via percutaneous biopsy.”
• Safety: Guided bronchoscopy “consistently produced fewer serious complications—such as pneumothorax and significant bleeding—than percutaneous approaches.”
• Lymph-node staging: Endobronchial ultrasound (EBUS) “continues to rival mediastinoscopy in diagnostic accuracy while offering lower morbidity for mediastinal assessment.”

Septimiu Murgu, MD, senior author and a Professor of Medicine at The University of Chicago, reflected on the findings and implications in a statement provided by IASLC.

“The current evidence supports the use of advanced bronchoscopic approaches for diagnosis, staging, and acquisition of tissue for comprehensive biomarker testing in one procedure, a truly patient-centered approach, regardless of whether material is needed for standard of care or clinical research,” Dr. Murgu said.

Officials explained that linear endobronchial guided sampling of accessible mediastinal lesions is “well established as a first-choice modality for lung cancer mediastinal staging,” but parenchymal lung lesions “are routinely accessed by either a percutaneous (CT-guided) or a bronchoscopic approach.”

They explained why it was critical to convene the multidisciplinary guideline panel and compared guided-bronchoscopy sampling with other methods in this setting.

“Direct comparisons between the percutaneous approach and bronchoscopy or endobronchial ultrasound (EBUS) and mediastinoscopy are sparse in regard to diagnostic accuracy, and it remains unknown which sampling technique is the safest and offers the most adequate material for comprehensive biomarker testing.”

The panel concluded that “available evidence suggests that guided-bronchoscopy sampling is of similar adequacy for comprehensive biomarker testing compared to percutaneous biopsy, while consistently demonstrating a better safety profile with fewer complications, especially with the use of contemporary advanced navigational bronchoscopic technologies.”