Plain-language summary
Bronchoscopic biopsies in suspected lung cancer often yield too little tissue for EGFR genotyping. This prospective single-centre study collected bronchoalveolar lavage fluid alongside the biopsy in 54 patients and tested extracellular-vesicle-derived DNA for EGFR variants. Among 49 patients with confirmed lung adenocarcinoma and evaluable results, overall concordance with tissue genotyping was 89.8 per cent, with positive agreement of 83.3 per cent and negative agreement of 96.0 per cent; where both methods called a variant, they agreed in every case, 20 of 20. In three of thirty assessable patients the lavage test added information that tissue alone had not delivered, including two whose initial biopsy was non-diagnostic and who were later confirmed to have adenocarcinoma.
Key findings
- Extracellular-vesicle-derived DNA in bronchoalveolar lavage fluid was tested for EGFR variants in 54 patients with suspected lung cancer.
- Among 49 evaluable adenocarcinoma patients, overall concordance with tissue genotyping was 89.8 per cent.
- Positive per cent agreement was 83.3 per cent and negative per cent agreement was 96.0 per cent.
- Among samples positive by both methods, variant-level calls agreed in every case (20 of 20).
- Additional molecular yield beyond tissue testing occurred in 3 of 30 assessable patients.
- Concordance was similar in early and advanced stage disease. This is a single-centre prospective series and needs confirmation at larger scale.
Why this matters for lung repair
Insufficient biopsy material is a routine obstacle in lung cancer diagnostics, and any test that recovers molecular information from fluid obtained during the same procedure is worth examining. This study uses the extracellular-vesicle fraction of lavage fluid as the DNA source, which is a more specific approach than testing whole fluid. The sample is small and single-centre, so the result is best read as a signal that deserves a larger multicentre trial rather than as a settled method.
Original abstract
Background: Tissue-based EGFR genotyping during the initial diagnostic work-up for suspected lung cancer is often limited by inadequate bronchoscopic biopsy material, and the clinical utility of bronchoalveolar lavage fluid (BALF) EGFR genotyping remains unclear. This study aimed to assess concordance between tissue and BALF EGFR genotyping and to determine whether BALF EGFR testing provides additional molecular diagnostic yield beyond tissue-based testing. Methods: In this prospective single-center study, adults with suspected lung cancer underwent bronchoscopic biopsy with BALF collection for extracellular vesicle-derived DNA EGFR testing. The primary endpoint was concordance between tissue and composite BALF EGFR genotyping in pathologically confirmed lung adenocarcinoma. Secondary endpoints included positive percent agreement (PPA), negative percent agreement (NPA), and additional molecular detection yield. An exploratory stage-based concordance analysis compared early-stage (stage I-II) with advanced-stage (stage III-IV) disease. Results: Among 54 patients with histopathologically confirmed lung adenocarcinoma, 49 had evaluable tissue and composite BALF EGFR results and were included in the primary analysis. The overall concordance rate was 89.8% [44/49; 95% confidence interval (CI), 78.2-95.6%], with a PPA of 83.3% (20/24; 95% CI, 64.1-93.3%) and an NPA of 96.0% (24/25; 95% CI, 80.5-99.3%). Variant-level agreement among double-positive cases was 100.0% (20/20). In an exploratory subgroup analysis, concordance was similar between early-stage (stage I-II) and advanced-stage (stage III-IV) disease (89.2% vs. 91.7%; P>0.99). Additional molecular detection yield beyond tissue-based testing was observed in 3 of 30 patients (10.0%), including one case of genotyping rescue among tissue wild-type cases and two cases of EGFR mutation detection among patients with unavailable tissue genotyping results. Notably, both of the latter patients had non-diagnostic initial bronchoscopic biopsy results and were subsequently confirmed as having lung adenocarcinoma. Conclusions: BALF EGFR genotyping showed high concordance with tissue EGFR results and provided additional molecular detection yield. BALF EGFR genotyping may complement tissue biopsy and improve molecular diagnostic yield in suspected lung cancer.
Frequently asked questions
What did this study find?
Bronchoscopic biopsies in suspected lung cancer often yield too little tissue for EGFR genotyping. This prospective single-centre study collected bronchoalveolar lavage fluid alongside the biopsy in 54 patients and tested extracellular-vesicle-derived DNA for EGFR variants. Among 49 patients with confirmed lung adenocarcinoma and evaluable results, overall concordance with tissue genotyping was 89.8 per cent, with positive agreement of 83.3 per cent and negative agreement of 96.0 per cent; where both methods called a variant, they agreed in every case, 20 of 20. In three of thirty assessable patients the lavage test added information that tissue alone had not delivered, including two whose initial biopsy was non-diagnostic and who were later confirmed to have adenocarcinoma.
Was this tested in humans or in the laboratory?
This paper reports a clinical study in human participants.
Where can I read the original paper?
The full text lives with the publisher: https://doi.org/10.21037/tlcr-2026-0664
Does this study prove that JuvGuard works?
No. This is an independent, peer-reviewed study on extracellular vesicles. JuvGuard references the published literature for education only. A single paper cannot establish that any product works, and nothing here is medical advice.
How to cite this paper
Kim Duk Ki, Hur Jae Young, Kim Hee Joung, Kim In Ae, Lee Jeong Eun, Chung Chaeuk et al.. Bronchoalveolar lavage fluid EGFR genotyping during bronchoscopic biopsy: concordance with tissue and additional molecular diagnostic yield in lung cancer.. Translational lung cancer research. 2026, 2026-09-11. DOI: 10.21037/tlcr-2026-0664
Source & verification
- Journal: Translational lung cancer research
- Published: 11 September 2026
- DOI: 10.21037/tlcr-2026-0664
- PubMed ID: 42723695
- Indexed via: pubmed
- MeSH terms: —