Role of endobronchial ultrasound in diagnosis and molecular assessment of metastatic melanoma

Barton Ruthven Jennings, Michael J. Millward, Benhur Amanuel, Siobhain Mulrennan, Simon A. Joosten, Martin J. Phillips

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11 Citations (Scopus)

Abstract

Background and objective: Vemurafenib is a new inhibitor of the mutated BRAF oncogene. In the presence of mutated BRAF in metastatic melanoma, treatment with vemurafenib leads to a reduction in mortality and in tumour progression when compared with chemotherapy. This study describes nine cases in which endobronchial ultrasound (EBUS) guided transbronchial needle aspiration (TBNA) was used to assess mediastinal and hilar lymph nodes for the presence of metastatic melanoma and demonstrates the ability to detect mutations in BRAF on the tissue obtained. Methods: A retrospective review was performed of all patients who had a history of melanoma and underwent EBUS TBNA to investigate hilar or mediastinal lymphadenopathy for the presence of metastatic melanoma. Results: In seven of the nine cases, metastatic melanoma was confirmed on cytology. The two negative cases were proven to be true negatives by follow up or by demonstrating an alternate diagnosis. In five cases, analysis for BRAF mutation was performed. Four cases were positive for mutation and one demonstrated wild-type BRAF. Conclusions: Tissue samples obtained from EBUS TBNA are adequate to diagnose metastatic melanoma in hilar and mediastinal lymph nodes and to detect the presence or absence of mutations in the BRAF gene. Our findings suggest that close collaboration between bronchoscopists and pathologists will be needed to implement BRAF testing in routine practice in the era of targeted therapy. Tissue samples obtained from EBUS TBNA of mediastinal and hilar lymph nodes are adequate to diagnose metastatic melanoma. This tissue can also be used to perform molecular analysis to detect mutations in the BRAF gene.

Original languageEnglish
Pages (from-to)991-996
Number of pages6
JournalRespirology
Volume17
Issue number6
DOIs
Publication statusPublished - Aug 2012
Externally publishedYes

Keywords

  • bronchoscopy and interventional technique
  • histology/cytology
  • immunohistochemistry
  • lung cancer
  • molecular biology

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