Safety and Sample Adequacy for Comprehensive Biomarker Testing of Bronchoscopic Biopsies: An American Association of Bronchology and Interventional Pulmonology (AABIP) and International Association for the Study of Lung Cancer (IASLC) Clinical Practice Guideline

Science and Research

Linear endobronchial (EBUS) guided sampling of accessible mediastinal lesions is well established as a first-choice modality for lung cancer mediastinal staging. Parenchymal lung lesions, however, are routinely accessed by either a percutaneous (CT-guided) or a bronchoscopic approach. Direct comparisons between the percutaneous approach and bronchoscopy, or 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. This guideline addresses new evidence and aims to answer these questions relevant to contemporary lung cancer clinical practice. A multidisciplinary expert panel from the AABIP and the Early Detection and Screening Committee of the IASLC was convened to address four PICO questions pertaining to the safety and adequacy of comprehensive biomarker testing for commonly used intra-thoracic biopsy techniques. The panel included 24 experts in thoracic procedures, including 18 pulmonologists, 2 radiologists, 1 pathologist and 3 thoracic surgeons from 22 hospitals across 12 countries. All panel members participated in the development of the final recommendations using a modified Delphi technique. Specific recommendations are provided on safety and adequacy of minimally invasive thoracic interventions on patients with confirmed or suspected lung cancer for which comprehensive biomarker testing is needed for standard of care or clinical trials participation.