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Can Molecular Profiling Be Accomplished Using EBUS-TBNA Samples?

T raditional treatment strategies for lung cancer involve some combination of surgery, chemotherapy, and radiation therapy. This is a reactive approach that only takes into account the stage and cell type of the patients’ lung cancer. Personalized/individualized medicine is an evolving medical model that emphasizes the customization of health care with all the decisions and treatments being tailored to individual patients. Future treatment strategies for lung cancer will be based on the systematic use of genetic or other information about an individual patient to select or optimize that patient’s therapeutic program. As Winston Churchill stated, “It is not the beginning of the end, but the end of the beginning.” The beginning includes recognition that lung cancer is a heterogenous disease with therapeutic responses that vary depending on the expression of certain oncogenes including endothelial growth factor receptor (EGFR), Kirsten rat sarcoma (KRAS), and anaplastic lymphoma kinase (ALK). The future will rely on the identification of specific molecular profiles for cancer of individual patients. Molecular profiling will lead to better prognostic and predictive factors, identification of new drugs and pathway targets, and help improve the therapeutic ratio. In the current issue of the Journal of Bronchology and Interventional Pulmonology, Nakajima et al report on the feasibility of isolating RNA, DNA, and protein from samples obtained using endobronchial ultrasoundguided transbronchial needle aspiration (EBUS-TBNA). RNA and DNA concentration and RNA quality were measured in 59 samples that had been archived for at least 1 year. The concentration of RNA and DNA was quite satisfactory, and RNA quality was well preserved. There is little debate that EBUS-TBNA has been one of the, if not the, most significant technologies introduced into the past decade for managing patients with lung cancer. Many believe that it has become the new gold standard for mediastinal assessment in patients with known or suspected lung cancer. Nakajima et al have shown that tissue sample size using EBUSTBNA is not a limitation for molecular profiling. EBUS-TBNA diffusion seems to be constrained because of 2 factors: availability of technology and educational/training programs for it use. The technology seems to be expanding, with the primary limitation being proper training. Several organizations such as the AABIP, ACCP, and Bronchoscopy International are creating web-based tools and face-to-face symposiums to address the second issue. A final comment: As I complete my tenure on the AABIP Board of Directors, I have been reflecting on where this organization had been and where it is going. I have had the privilege of 2 visits to this board. The first was early in my career, when I was fortunate enough to be mentored by some