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Objective To examine epidermal growth factor receptor (EGFR) gene mutations in small bronchoscopic biopsy specimens, so as to provide guidance for clinical targeted therapy. Methods Fifty-six female patients with advanced-stage III B-IV lung adenocarcinoma underwent endoscopic endobronchial biopsy of tumor tissues or transbronchial needle aspiration of mediastinal and hilar lymph nodes. Under the endoscope, 20 patients underwent only bronchial biopsy, 28 underwent only transbronchial needle aspiration (TBNA) lymph node biopsy, and 8 underwent both endobronchial biopsy and TBNA biopsy of mediastinal and hilar lymph nodes. A total of 64 specimens were collected and were subjected to detection of EGFR gene mutations after confirmation of lung adenocarcinoma. The specimens were then divided into endobronchial metastasis group and lymph node metastasis group, and the mutations of exons 19 and 21 were detected and the clinical efficacy of targeted therapy was analyzed. Results Exon 19 had higher positive rate in the endobronchial metastasis group (χ2=4.304,P=0.038), and exon 21 had higher positive rate in lymph node metastasis group (χ2=18.727,P=0.000). A total of 24 cases were included for the clinical efficacy assessments: 10 had endobronchial metastasis (exon 19 mutations in 8 cases, 21 exon in 2 cases), with the disease control rate being 90% (9/10) and median progression-free survival period being 14.8 months; 14 patients had lymph node metastasis (19 exon 3 cases, 21 exon 11 cases), with the disease control rate being 78.57% (11/14) and the median progression-free survival period being 9.2 months; the disease control rates were not significantly different between the two groups (P>0.05) and the median progression-free survival periods were significantly different between the two groups(χ2 = 4.134, P=0.042). Conclusion Mutations of different EGFR exons might relate to the metastasis forms of female advanced lung adenocarcinoma, with exon 19 prone to endobronchial metastasis and exon 21 to lymph node metastasis. Targeted therapy for patients with endobronchial metastasis has a better outcome than that for patients with lymph node metastasis.
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Objective To retrospectively analyze the incidence of bleeding during transbronchial needle aspiration (TBNA) procedures, so as to provide evidence for prevention and treatment of the condition. Methods TBNA procedures were performed in 178 patients with enlarged mediastinal and/or hilar lymph nodes, who were treated in the People's Hospital of Linyi. A total of 248 lymph node sites were punctured, including 100 for the groups of pretracheal and post-superior vena cava lymph nodes (4R), 10 for the groups of left paratracheal (aorta-pulmonary artery windows) lymph nodes (4L), 13 for the groups of pre-carinal lymph nodes (7),90 for the groups of sub-carinal lymph nodes (7), 12 for the groups of sub-subcarinal lymph nodes (7), 12 for the groups of right lung hilar lymph nodes (11R), and 11 for the groups of left lung hilar lymph nodes (11L).TBNA procedures were performed according to WANG's TBNA positioning and punctured method. The sites and incidence rates of bleeding sites during the procedures were analyzed. Results The highest incidence rate of bleeding (20%) was found during TBNA procedures in the sub-carinal lymph node groups (7), and the lowest incidence rate was found (2%) in the pretracheal and post-superior vena cava lymph node groups (4R).The incidence rates of bleeding were significantly different between different puncture sites as demonstrated by chi-square test (χ2=17.035,P=0.009). Conclusion Pretracheal and post-superior vena cava lymph nodes (4R) and sub-carinal lymph nodes (7) are the most common TBNA puncture position in the airway. TBNA procedure at sub-carinal lymph nodes (7) has the highest risk of bleeding. The massive bleeding during TBNA procedures can be avoided by prior enhanced CT and/or endobronchial ultrasound (EBUS)-TBNA of the lung.