With the advent of various molecular targeted drugs, next-generation sequencing (NGS) has been used for unresectable non-small cell lung cancer (NSCLC). Although advances in multidisciplinary treatment have led to NGS being also considered in resectable cases, it is unclear whether bronchoscopic specimens can be used as in unresectable cases.
All patients diagnosed with NSCLC and whose bronchoscopic specimens were submitted to NGS at our hospital from October 2019 to December 2021 were extracted. The targets included endobronchial lesions (ELs), peri-tracheal/bronchial lesions (PLs) using convex probe endobronchial ultrasound (EBUS), and lung lesions (LLs) using radial EBUS. After dividing the cases into potentially resectable and unresectable groups, the NGS success rate of each procedure and its associated factors were examined.Of the eligible 450 cases, 128 (28.4%) were potentially resectable. For ELs, NGS was successful in all but one case, with comparable results in the potentially resectable and unresectable groups (90.0% vs 100%, p=0.389). For PLs, NGS success rates were also equivalent between the two groups, although slightly lower than for ELs (84.2% vs 85.5%, p=0.500). In univariable analysis, cases with 22-G needles had a higher success rate than those with 25-G (88.3% vs 77.8%, p=0.062). Meanwhile, NGS success rates for LLs tended to be lower in the potentially resectable group (76.2% vs 85.7%, p=0.148). Univariable analysis showed lesions located away from the costal pleura (90.7% vs 78.0%, p=0.026) and at the hilar side (88.1% vs 77.0%, p=0.064) had higher success rates, respectively.

In conclusion, NGS using bronchoscopic specimens in resectable NSCLC was generally as feasible as in unresectable cases. Provided it should be approached for ELs and PLs if possible.