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Their action is based on the ability of some tumors to evade the immune system through the expression of PD-L1&#44; a ligand for a protein called PD-1 &#40;programmed cell death protein 1&#41;&#46; When PD-1 and PD-L1 bind&#44; T cell activation is inhibited&#44; thus blocking the normal immune response to tumor cells&#46; Some of these therapies are already approved for the treatment of lung cancer&#44; and show longer survival rates than those obtained with conventional chemotherapy&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">One of the most important challenges in the use of PD-L1 inhibitors is correct patient selection&#46; One of the most commonly used markers is PD-L1 expression in tumor cells&#44; which is evaluated using immunohistochemical techniques&#46; Pembrolizumab is an anti-PD-1 monoclonal antibody approved for the treatment of NSCLC&#46; First-line therapy with pembrolizumab requires that at least 50&#37; of the tumor cells express PD-L1&#44; and for second-line therapy&#44; at least 1&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The studies that led to the approval of anti-PD-L1 therapies were all conducted using large tissue samples from either excisional biopsies or core biopsies&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">5&#8211;7</span></a> Such samples are not always available in NSCLC patients&#44; since diagnosis is often made with smaller samples obtained with endobronchial ultrasound-guided transbronchial needle aspiration &#40;EBUS-TBNA&#41;&#46; This is a minimally invasive technique that has been recommended by many scientific societies as the diagnostic procedure of choice in central airway lesions or those which require mediastinal staging&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">8&#44;9</span></a> The usefulness of this type of biopsy for measuring PD-L1 expression is unclear&#44; and may differ in terms of diagnostic accuracy&#44; fundamentally because of the number of tumor cells in these samples&#46; We report here on the feasibility of determining PD-L1 expression in NSCLC samples obtained by EBUS-TBNA&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">We conducted a retrospective review of all NSCLC cases in whom PD-L1 studies were requested&#46; The cases were identified from the pathology laboratory database&#44; and we included all patients seen between July 1&#44; 2015&#44; when this technique was first available in our hospital&#44; and June 1&#44; 2017&#46; The study was approved by the ethics committee of our institution&#46; Histopathological diagnosis and PD-L1 expression analysis were performed by an expert pathologist specializing in lung diseases&#46; Samples were considered adequate for PD-L1 staining if they contained more than 100 evaluable cancer cells&#46; The samples were fixed in 4&#37; formaldehyde&#44; buffered&#44; and embedded in paraffin&#59; 4<span class="elsevierStyleHsp" style=""></span>&#956;m tissue slices were cut and stained with hematoxylin&#8211;eosin&#44; and incubated with anti-PD-L1monoclonal antibody &#40;E1L3N<span class="elsevierStyleSup">&#174;</span>&#41; XP<span class="elsevierStyleSup">&#174;</span> Rabbit mAb in the Ventana Benchmark ULTRA automated system &#40;Roche&#41;&#44; according to the recommendations of the manufacturer&#46; PD-L1 expression was evaluated with a manual count of the percentage of cancer cells with membrane staining&#44; whether partial or complete&#44; and irrespective of intensity &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#8211;D&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">All samples from the total 23 requests for PD-L1 determination were adequate for the procedure&#46; Of these 23 cases&#44; 18 were adenocarcinomas&#44; 3 squamous cell carcinoma&#44; 1 adenosquamous&#44; and 1 unspecified non-small cell carcinoma&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Mean age was 70 years &#40;range 41&#8211;88&#41;&#44; and most patients &#40;12&#47;23&#44; 52&#37;&#41; were women&#46; The samples were lymph node aspirates in 20&#47;23 patients &#40;87&#37;&#41;&#44; and the others were from lesions adjacent to the central airway&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Among the 23 cases analyzed&#44; we found 3 &#40;13&#46;04&#37;&#41; samples with PD-L1 staining in &#62;50&#37; of the cancer cells&#44; 6 &#40;26&#46;08&#37;&#41; with staining in 1&#37;&#8211;50&#37;&#44; and 14 &#40;60&#46;86&#37;&#41; with staining in &#60;1&#37;&#46; Of the 14 cases with staining in &#60;1&#37;&#44; 11 showed no staining&#46; The results of anti-PD-L1 immunohistochemical staining in cancer cells are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">This study suggests that&#44; similarly to their use in the determination of the most common mutations&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">10</span></a> in a high percentage of cases&#44; EBUS-TBNA samples are adequate for evaluating PD-L1 expression in cancer cells&#46; Only 13&#37; of samples were positive&#44; defined as staining of more than 50&#37; of the cancer cells &#40;95&#37; CI&#58; 0&#46;028&#8211;0&#46;336&#41;&#44; while the vast majority of cases were negative for PD-L1 expression&#46; When 1&#37; was used as a cut-off point&#44; positivity rose to 26&#37; &#40;95&#37; CI&#58; 0&#46;10&#8211;0&#46;48&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Very few studies have evaluated PD-L1 expression in samples obtained by EBUS-TBNA&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">11&#44;12</span></a> Larger biopsy samples yield PD-L1 positivity of around 50&#37; with a cohort cut-off point &#62;50&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">7&#44;13</span></a> Although these figures appear to be higher than those observed in our group&#44; this may be a chance occurrence&#44; due to the limited number of cases in our series &#40;reflected by the wide confidence interval&#41;&#46; If the number of PD-L1-positive samples really is lower than reported in the literature&#44; this may be associated with ethnic differences among our population&#44; and also with differences in the techniques used&#44; for example&#44; due to tumor heterogeneity&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">This is the first study in South America to evaluate the feasibility of measuring PD-L1 in EBUS-TBNA samples&#46; Unfortunately&#44; it has the limitations associated with a small number of patients&#44; and a population recruited from the same hospital&#46; It should be noted that while it is possible to measure PD-L1 in samples obtained by EBUS&#44; we cannot determine if the positivity observed in samples obtained by needle aspiration is representative of positivity in the primary tumor&#44; and&#44; more importantly&#44; if these samples are useful for predicting response to therapy&#46; These questions must be answered in further studies&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Fernandez-Bussy S&#44; Pires Y&#44; Labarca G&#44; Vial MR&#46; Expresi&#243;n de PD-L1 en muestras de c&#225;ncer pulmonar no microc&#237;tico obtenidas por EBUS-TBNA&#46; Arch Bronconeumol&#46; 2018&#59;54&#58;290&#8211;292&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Microscopic images of the tumor samples obtained by EBUS-TBNA and of the respective immunohistochemical stains with anti-PD-L1 E1L3N antibody&#46; &#40;A&#41; Adenocarcinoma &#40;hematoxylin&#8211;eosin&#44; 40&#215;&#41;&#46; &#40;B&#41; Membrane staining of &#62;50&#37; of cancer cells &#40;PD-L1 E1L3N XP Rabbit mAb&#44; 40&#215;&#41;&#46; &#40;C&#41; Adenocarcinoma &#40;hematoxylin&#8211;eosin&#44; 40&#215;&#41;&#46; &#40;D&#41; Membrane staining of &#62;1&#37; of cancer cells &#40;PD-L1 E1L3N XP Rabbit mAb&#44; 40&#215;&#41;&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age&#44; mean</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Source of sample</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lymph node&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lung&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">PD-L1 expression</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1&#8211;10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>10&#8211;50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>50&#8211;100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
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Scientific Letter
PD-L1 Expression in a Non-Small Cell Lung Cancer Specimen Obtained by EBUS-TBNA
Expresión de PD-L1 en muestras de cáncer pulmonar no microcítico obtenidas por EBUS-TBNA
Sebastián Fernandez-Bussya,
Corresponding author
sfernandezbussy@alemana.cl

Corresponding author.
, Yumay Piresb, Gonzalo Labarcac,d, Macarena R. Viala
a Unidad de Neumología Intervencionista, Clínica Alemana de Santiago-Universidad del Desarrollo, Santiago, Chile
b Departmento de Anatomía Patológica, Clínica Alemana de Santiago-Universidad del Desarrollo, Santiago, Chile
c Facultad de Medicina, Universidad San Sebastián, Concepción, Chile
d Departamento de Medicina Interna, Complejo Asistencial Dr. Víctor Ríos Ruiz, Los Ángeles, Chile
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        "titulo" => "Expresi&#243;n de PD-L1 en muestras de c&#225;ncer pulmonar no microc&#237;tico obtenidas por EBUS-TBNA"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Microscopic images of the tumor samples obtained by EBUS-TBNA and of the respective immunohistochemical stains with anti-PD-L1 E1L3N antibody&#46; &#40;A&#41; Adenocarcinoma &#40;hematoxylin&#8211;eosin&#44; 40&#215;&#41;&#46; &#40;B&#41; Membrane staining of &#62;50&#37; of cancer cells &#40;PD-L1 E1L3N XP Rabbit mAb&#44; 40&#215;&#41;&#46; &#40;C&#41; Adenocarcinoma &#40;hematoxylin&#8211;eosin&#44; 40&#215;&#41;&#46; &#40;D&#41; Membrane staining of &#62;1&#37; of cancer cells &#40;PD-L1 E1L3N XP Rabbit mAb&#44; 40&#215;&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Lung cancer is the leading cause of cancer death worldwide among both men and women&#44; accounting for 1&#46;6 million deaths annually&#46; In Chile&#44; it is the second leading cause of death due to cancer&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">1&#44;2</span></a> Non-small cell lung cancer &#40;NSCLC&#41; accounts for 85&#37; of lung cancers&#59; unfortunately&#44; up to 80&#37; of cases are diagnosed in advanced stages&#44; requiring systemic therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">3</span></a> In recent decades&#44; significant advances have been made in the treatment of these patients&#44; with the development of therapies aimed at specific mutations of the tumor cells &#40;targeted therapies&#41; and more recently with immunotherapy&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Among the most widely used immunotherapies are monoclonal antibodies against PD-1 or PD-L1&#46; Their action is based on the ability of some tumors to evade the immune system through the expression of PD-L1&#44; a ligand for a protein called PD-1 &#40;programmed cell death protein 1&#41;&#46; When PD-1 and PD-L1 bind&#44; T cell activation is inhibited&#44; thus blocking the normal immune response to tumor cells&#46; Some of these therapies are already approved for the treatment of lung cancer&#44; and show longer survival rates than those obtained with conventional chemotherapy&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">One of the most important challenges in the use of PD-L1 inhibitors is correct patient selection&#46; One of the most commonly used markers is PD-L1 expression in tumor cells&#44; which is evaluated using immunohistochemical techniques&#46; Pembrolizumab is an anti-PD-1 monoclonal antibody approved for the treatment of NSCLC&#46; First-line therapy with pembrolizumab requires that at least 50&#37; of the tumor cells express PD-L1&#44; and for second-line therapy&#44; at least 1&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The studies that led to the approval of anti-PD-L1 therapies were all conducted using large tissue samples from either excisional biopsies or core biopsies&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">5&#8211;7</span></a> Such samples are not always available in NSCLC patients&#44; since diagnosis is often made with smaller samples obtained with endobronchial ultrasound-guided transbronchial needle aspiration &#40;EBUS-TBNA&#41;&#46; This is a minimally invasive technique that has been recommended by many scientific societies as the diagnostic procedure of choice in central airway lesions or those which require mediastinal staging&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">8&#44;9</span></a> The usefulness of this type of biopsy for measuring PD-L1 expression is unclear&#44; and may differ in terms of diagnostic accuracy&#44; fundamentally because of the number of tumor cells in these samples&#46; We report here on the feasibility of determining PD-L1 expression in NSCLC samples obtained by EBUS-TBNA&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">We conducted a retrospective review of all NSCLC cases in whom PD-L1 studies were requested&#46; The cases were identified from the pathology laboratory database&#44; and we included all patients seen between July 1&#44; 2015&#44; when this technique was first available in our hospital&#44; and June 1&#44; 2017&#46; The study was approved by the ethics committee of our institution&#46; Histopathological diagnosis and PD-L1 expression analysis were performed by an expert pathologist specializing in lung diseases&#46; Samples were considered adequate for PD-L1 staining if they contained more than 100 evaluable cancer cells&#46; The samples were fixed in 4&#37; formaldehyde&#44; buffered&#44; and embedded in paraffin&#59; 4<span class="elsevierStyleHsp" style=""></span>&#956;m tissue slices were cut and stained with hematoxylin&#8211;eosin&#44; and incubated with anti-PD-L1monoclonal antibody &#40;E1L3N<span class="elsevierStyleSup">&#174;</span>&#41; XP<span class="elsevierStyleSup">&#174;</span> Rabbit mAb in the Ventana Benchmark ULTRA automated system &#40;Roche&#41;&#44; according to the recommendations of the manufacturer&#46; PD-L1 expression was evaluated with a manual count of the percentage of cancer cells with membrane staining&#44; whether partial or complete&#44; and irrespective of intensity &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#8211;D&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">All samples from the total 23 requests for PD-L1 determination were adequate for the procedure&#46; Of these 23 cases&#44; 18 were adenocarcinomas&#44; 3 squamous cell carcinoma&#44; 1 adenosquamous&#44; and 1 unspecified non-small cell carcinoma&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Mean age was 70 years &#40;range 41&#8211;88&#41;&#44; and most patients &#40;12&#47;23&#44; 52&#37;&#41; were women&#46; The samples were lymph node aspirates in 20&#47;23 patients &#40;87&#37;&#41;&#44; and the others were from lesions adjacent to the central airway&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Among the 23 cases analyzed&#44; we found 3 &#40;13&#46;04&#37;&#41; samples with PD-L1 staining in &#62;50&#37; of the cancer cells&#44; 6 &#40;26&#46;08&#37;&#41; with staining in 1&#37;&#8211;50&#37;&#44; and 14 &#40;60&#46;86&#37;&#41; with staining in &#60;1&#37;&#46; Of the 14 cases with staining in &#60;1&#37;&#44; 11 showed no staining&#46; The results of anti-PD-L1 immunohistochemical staining in cancer cells are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">This study suggests that&#44; similarly to their use in the determination of the most common mutations&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">10</span></a> in a high percentage of cases&#44; EBUS-TBNA samples are adequate for evaluating PD-L1 expression in cancer cells&#46; Only 13&#37; of samples were positive&#44; defined as staining of more than 50&#37; of the cancer cells &#40;95&#37; CI&#58; 0&#46;028&#8211;0&#46;336&#41;&#44; while the vast majority of cases were negative for PD-L1 expression&#46; When 1&#37; was used as a cut-off point&#44; positivity rose to 26&#37; &#40;95&#37; CI&#58; 0&#46;10&#8211;0&#46;48&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Very few studies have evaluated PD-L1 expression in samples obtained by EBUS-TBNA&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">11&#44;12</span></a> Larger biopsy samples yield PD-L1 positivity of around 50&#37; with a cohort cut-off point &#62;50&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">7&#44;13</span></a> Although these figures appear to be higher than those observed in our group&#44; this may be a chance occurrence&#44; due to the limited number of cases in our series &#40;reflected by the wide confidence interval&#41;&#46; If the number of PD-L1-positive samples really is lower than reported in the literature&#44; this may be associated with ethnic differences among our population&#44; and also with differences in the techniques used&#44; for example&#44; due to tumor heterogeneity&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">This is the first study in South America to evaluate the feasibility of measuring PD-L1 in EBUS-TBNA samples&#46; Unfortunately&#44; it has the limitations associated with a small number of patients&#44; and a population recruited from the same hospital&#46; It should be noted that while it is possible to measure PD-L1 in samples obtained by EBUS&#44; we cannot determine if the positivity observed in samples obtained by needle aspiration is representative of positivity in the primary tumor&#44; and&#44; more importantly&#44; if these samples are useful for predicting response to therapy&#46; These questions must be answered in further studies&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Fernandez-Bussy S&#44; Pires Y&#44; Labarca G&#44; Vial MR&#46; Expresi&#243;n de PD-L1 en muestras de c&#225;ncer pulmonar no microc&#237;tico obtenidas por EBUS-TBNA&#46; Arch Bronconeumol&#46; 2018&#59;54&#58;290&#8211;292&#46;</p>"
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age&#44; mean</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Source of sample</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lymph node&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lung&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">PD-L1 expression</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;1&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
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                    0 => array:2 [
                      "doi" => "10.3322/caac.21332"
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                        "fecha" => "2016"
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                  "host" => array:1 [
                    0 => array:2 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "AJRCCM&#58; 100-year anniversary&#46; The shifting landscape for lung cancer&#58; past&#44; present&#44; and future"
                      "autores" => array:1 [
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                          "etal" => false
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Article information
ISSN: 15792129
Original language: English
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