{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:32:55Z","timestamp":1787027575016,"version":"build-2736575974"},"reference-count":25,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,1,12]],"date-time":"2023-01-12T00:00:00Z","timestamp":1673481600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ARM"],"abstract":"<jats:p>Introduction: The role of EBUS-TBNA in the diagnosis and staging of lung cancer is well established. EBUS-TBNA can be performed using different aspiration techniques. The most common aspiration technique is known as \u201csuction\u201d. One alternative to the suction technique is the slow-pull capillary aspiration. To the best of our knowledge, no studies have assessed the diagnostic yield of slow-pull capillary EBUS-TBNA in PD-L1 amplification assessment in NSCLC. Herein, we conducted a single-centre retrospective study to establish the diagnostic yield of slow-pull capillary EBUS-TBNA in terms of PD-L1 in patients with NSCLC and hilar\/mediastinal lymphadenopathies subsequent to NSCLC. Materials and Methods: Patients with hilar and\/or mediastinal lymph node (LN) NSCLC metastasis, diagnosed by EBUS-TBNA between January 2021 and April 2022 at Pulmonology Unit of \u201cOspedali Riuniti di Ancona\u201d (Ancona, Italy) were enrolled. We evaluated patient characteristics, including demographic information, CT scan\/ FDG-PET features and final histological diagnoses, including PD-L1 assessment. Results: A total of 174 patients underwent EBUS-TBNA for diagnosis of hilar\/mediastinal lymphadenopathies between January 2021 and April 2022 in the Interventional Pulmonology Unit of the \u201cOspedali Riuniti di Ancona\u201d. Slow-pull capillary aspiration was adopted in 60 patients (34.5%), and in 30\/60 patients (50.0%) NSCLC was diagnosed. EBUS-TBNA with slow-pull capillary aspiration provided adequate sampling for molecular biology and PD-L1 testing in 96.7% of patients (29\/30); in 15\/29 (51.7%) samples with more than 1000 viable cells\/HPF were identified, whereas in 14\/29 (48.3%) samples contained 101\u20131000 viable cells\/HPF. Conclusion: These retrospective study shows that slow-pull capillary aspiration carries an excellent diagnostic accuracy, almost equal to that one reported in literature, supporting its use in EBUS-TBNA for PD-L1 testing in NSCLC.<\/jats:p>","DOI":"10.3390\/arm91010001","type":"journal-article","created":{"date-parts":[[2023,1,13]],"date-time":"2023-01-13T03:28:10Z","timestamp":1673580490000},"page":"1-8","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Diagnostic Accuracy of Slow-Capillary Endobronchial Ultrasound Needle Aspiration in Determining PD-L1 Expression in Non-Small Cell Lung Cancer"],"prefix":"10.3390","volume":"91","author":[{"given":"Lina","family":"Zuccatosta","sequence":"first","affiliation":[{"name":"Pulmonary Diseases Unit, Azienda Ospedali Riuniti, Via Conca 71, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1887-5377","authenticated-orcid":false,"given":"Federico","family":"Mei","sequence":"additional","affiliation":[{"name":"Pulmonary Diseases Unit, Azienda Ospedali Riuniti, Via Conca 71, 60126 Ancona, Italy"},{"name":"Pulmonary Disease Unit, Dipartimento di Scienze Biomediche e Sanit\u00e0 Pubblica, Polytechnic University of Marche, Via Conca 71, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Sediari","sequence":"additional","affiliation":[{"name":"Pulmonary Diseases Unit, Azienda Ospedali Riuniti, Via Conca 71, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Di Marco Berardino","sequence":"additional","affiliation":[{"name":"Pulmonary Diseases Unit, Azienda Ospedali Riuniti, Via Conca 71, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Bonifazi","sequence":"additional","affiliation":[{"name":"Pulmonary Diseases Unit, Azienda Ospedali Riuniti, Via Conca 71, 60126 Ancona, Italy"},{"name":"Pulmonary Disease Unit, Dipartimento di Scienze Biomediche e Sanit\u00e0 Pubblica, Polytechnic University of Marche, Via Conca 71, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Barbisan","sequence":"additional","affiliation":[{"name":"Pathological Anatomy Institute, Polytechnic University of Marche, Via Conca 71, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaia","family":"Goteri","sequence":"additional","affiliation":[{"name":"Pathological Anatomy Institute, Polytechnic University of Marche, Via Conca 71, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Gasparini","sequence":"additional","affiliation":[{"name":"Pulmonary Diseases Unit, Azienda Ospedali Riuniti, Via Conca 71, 60126 Ancona, Italy"},{"name":"Pulmonary Disease Unit, Dipartimento di Scienze Biomediche e Sanit\u00e0 Pubblica, Polytechnic University of Marche, Via Conca 71, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Gonnelli","sequence":"additional","affiliation":[{"name":"Pulmonary Diseases Unit, Azienda Ospedali Riuniti, Via Conca 71, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1230","DOI":"10.1016\/j.chest.2020.04.059","article-title":"Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for PD-L1 Testing in Non-small Cell Lung Cancer","volume":"158","author":"Perrotta","year":"2020","journal-title":"Chest"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1590\/S1806-37132015000004466","article-title":"Diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration for mediastinal staging in lung cancer","volume":"41","author":"Labarca","year":"2015","journal-title":"J. Bras. Pneumol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1007\/s11748-013-0224-6","article-title":"Current status and perspective of EBUS-TBNA","volume":"61","author":"Nakajima","year":"2013","journal-title":"Gen. Thorac. Cardiovasc. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1156","DOI":"10.1183\/09031936.00097908","article-title":"Effectiveness and safety of endobronchial ultrasound-transbronchial needle aspiration: A systematic review","volume":"33","year":"2009","journal-title":"Eur. Respir. J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"115","DOI":"10.4103\/2303-9027.156737","article-title":"Comparison of cytologic accuracy of endobronchial ultrasound transbronchial needle aspiration using needle suction versus no suction","volume":"4","author":"Harris","year":"2015","journal-title":"Endosc. Ultrasound"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1378\/chest.11-0692","article-title":"Randomized Clinical Trial of Endobronchial Ultrasound Needle Biopsy with and without Aspiration","volume":"142","author":"Casal","year":"2012","journal-title":"Chest"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1378\/chest.15-1216","article-title":"Technical Aspects of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: CHEST Guideline and Expert Panel Report","volume":"149","author":"Wahidi","year":"2016","journal-title":"Chest"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1038\/nm730","article-title":"Tumor-associated B7-H1 promotes T-cell apoptosis: A potential mechanism of immune evasion","volume":"8","author":"Dong","year":"2002","journal-title":"Nat. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"i1","DOI":"10.1136\/thoraxjnl-2013-203618","article-title":"British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults: Accredited by NICE","volume":"68","author":"Blaikley","year":"2013","journal-title":"Thorax"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1159\/000085370","article-title":"Contraindications and Safety of Transbronchial Lung Biopsy via Flexible Bronchoscopy","volume":"72","author":"Wahidi","year":"2005","journal-title":"Respiration"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1675","DOI":"10.1097\/JTO.0000000000000678","article-title":"The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Proposals for the Revision of the N Descriptors in the Forthcoming 8th Edition of the TNM Classification for Lung Cancer","volume":"10","author":"Asamura","year":"2015","journal-title":"J. Thorac. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.ejca.2008.10.028","article-title":"Evaluation of lymph nodes with RECIST 1.1","volume":"45","author":"Schwartz","year":"2009","journal-title":"Eur. J. Cancer"},{"key":"ref_13","first-page":"1313","article-title":"Lymphadenopathy: Differential diagnosis and evaluation","volume":"58","author":"Ferrer","year":"1998","journal-title":"Am. Fam. Physician"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e480","DOI":"10.1007\/s00330-014-3420-6","article-title":"Quantitative CT texture and shape analysis: Can it differentiate benign and malignant mediastinal lymph nodes in patients with primary lung cancer?","volume":"25","author":"Bayanati","year":"2015","journal-title":"Eur. Radiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1007\/s11548-019-01948-8","article-title":"Semantic segmentation and detection of mediastinal lymph nodes and anatomical structures in CT data for lung cancer staging","volume":"14","author":"Bouget","year":"2019","journal-title":"Int. J. Comput. Assist. Radiol. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1378\/chest.13-0756","article-title":"The Role of the Pulmonologist in Rapid On-site Cytologic Evaluation of Transbronchial Needle Aspiration: A prospective study","volume":"145","author":"Bonifazi","year":"2014","journal-title":"Chest"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2022","DOI":"10.3389\/fimmu.2019.02022","article-title":"PD-L1 Distribution and Perspective for Cancer Immunotherapy\u2014Blockade, Knockdown, or Inhibition","volume":"10","author":"Wu","year":"2019","journal-title":"Front. Immunol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1093\/annonc\/mdy126","article-title":"Cytology cell blocks are suitable for immunohistochemical testing for PD-L1 in lung cancer","volume":"29","author":"Wang","year":"2018","journal-title":"Ann. Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"72","DOI":"10.4103\/JOC.JOC_100_19","article-title":"Processing and reporting of cytology specimens from mediastinal lymph nodes collected using endobronchial ultrasound-guided transbronchial needle aspiration: A state-of-the-art review","volume":"37","author":"Agarwal","year":"2020","journal-title":"J. Cytol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Bianco, A., Perrotta, F., Barra, G., Malapelle, U., Rocco, D., and De Palma, R. (2019). Prognostic Factors and Biomarkers of Responses to Immune Checkpoint Inhibitors in Lung Cancer. Int. J. Mol. Sci., 20.","DOI":"10.3390\/ijms20194931"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1016\/j.cllc.2016.12.002","article-title":"EBUS-TBNA as a Promising Method for the Evaluation of Tumor PD-L1 Expression in Lung Cancer","volume":"18","author":"Sakakibara","year":"2017","journal-title":"Clin. Lung Cancer"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Lin, X., Ye, M., Li, Y., Ren, J., Lou, Q., Li, Y., Jin, X., Wang, K.-P., and Chen, C. (2018). Randomized controlled trial to evaluate the utility of suction and inner-stylet of EBUS-TBNA for mediastinal and hilar lymphadenopathy. BMC Pulm. Med., 18.","DOI":"10.1186\/s12890-018-0751-0"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1753466620907037","DOI":"10.1177\/1753466620907037","article-title":"Slow-pull capillary technique versus suction technique in endobronchial ultrasound-guided transbronchial needle aspiration for diagnosing diseases involving hilar and mediastinal lymph node enlargement","volume":"14","author":"He","year":"2020","journal-title":"Ther. Adv. Respir. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1002\/cncy.21941","article-title":"Programmed death-ligand 1 testing of lung cancer cytology specimens obtained with bronchoscopy","volume":"126","author":"Stoy","year":"2018","journal-title":"Cancer Cytopathol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1002\/cncy.21937","article-title":"PD-L1 expression in non-small cell lung carcinoma: Comparison among cytology, small biopsy, and surgical resection specimens","volume":"125","author":"Heymann","year":"2017","journal-title":"Cancer Cytopathol."}],"container-title":["Advances in Respiratory Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2543-6031\/91\/1\/1\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:04:22Z","timestamp":1760119462000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2543-6031\/91\/1\/1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,12]]},"references-count":25,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["arm91010001"],"URL":"https:\/\/doi.org\/10.3390\/arm91010001","relation":{},"ISSN":["2543-6031"],"issn-type":[{"value":"2543-6031","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,12]]}}}