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Background  Conventional transbronchial needle aspiration (TBNA) is advantageous for the one‐step diagnosis and staging of lung adenocarcinoma under topical anesthesia and conscious sedation. We examined its efficacy for identifying  EGFR  mutations.    Methods  Forty‐seven patients with proven or suspected lung adenocarcinoma indicated for hilar‐mediastinal lymph node (LN) staging between June 2011 and December 2017 were enrolled. The cellblock was prepared using the plasma‐thrombin method. TaqMan PCR was used to detect mutations. Considering cost effectiveness, only the sample with the highest tumor cell fraction in the same patient was chosen for analysis.    Results  TBNA provided positive results of malignancy in 27 patients. Seventeen patients (63.0%) had cellblocks eligible for mutation testing. Bronchial biopsy ( n  = 6), neck LN fine needle aspiration ( n =  1), and brushing ( n =  1), provided higher tumor cell fractions for analysis in eight patients. TBNA was the exclusive method used in nine patients (19.1%). For patients with an inadequate TBNA cellblock, bronchial biopsy ( n =  5), neck LN fine needle aspiration ( n =  3), computed tomography‐guided transthoracic needle biopsy ( n  = 1), and brushing ( n  = 1) were used for analysis. Modification to specimen processing to prevent exhaustion by cytology after June 2016 improved the adequacy of cellblock samples (9/10, 90% vs. 8/17, 47.1%;  P  = 0.042).    Conclusions  These findings suggest the promising role of conventional TBNA and highlight the challenges of doing more with less in an era of precision medicine.

Conventional transbronchial needle aspiration is promising for identifying EGFR mutations in lung adenocarcinoma