Personalized treatment of metastatic non-squamous non-small cell lung cancer (NSCLC) requires detailed molecular characterization of the tumor, including detection of predictive driver mutations and programmed death ligand 1 (PD-L1) expression. This case report demonstrates that in a patient with NSCLC, where several procedures (pleural puncture, transthoracic lung biopsy, and EBUS-TBNA) failed to provide sufficient tumor material, only EBUS-guided transbronchial lymph node cryobiopsy (EBUS-TBLNC) enabled complete immunohistochemical and genetic tumor characterization. This characterization revealed PD-L1 expression in 100% of tumor cells without actionable genetic alterations, leading to the initiation of immunotherapy.

Jürgen Hetzel, Laetitia A Mauti, Jonas Winkler, Sabine Cardoso Almeida, Philip Jermann, Miklos Pless, Lukas Bubendorf, Peter Karl Bode, Maik Häntschel