Despite the widespread application of next-generation sequencing (NGS) in advanced lung adenocarcinoma, its impact on survival and the optimal timing for the examination remain uncertain. This cohort study included advanced lung adenocarcinoma patients who underwent NGS testing. We categorized patients into four groups: Group 1: treatment-naïve, upfront NGS; Group 2: Treatment-naïve, exclusionary EGFR/ALK/ROS1; Group 3: post-treatment, no known EGFR/ALK/ROS1; Group 4: known driver mutation and post-TKI treatment. A total of 424 patients were included. There were 128, 126, 90, and 80 patients in Groups 1, 2, 3, and 4, respectively. In Groups 1, 2, 3, and 4, targetable mutations were identified in 76.6%, 49.2%, 41.1%, and 33.3% of the patients, respectively (p < 0.001). Mutation-targeted treatments were applied in 68.0%, 15.1%, 27.8%, and 22.5% of the patients, respectively (p < 0.001). In the overall population, patients receiving mutation-targeted treatments exhibited significantly longer overall survival (OS) (aHR 0.54 [95% CI 0.37–0.79], p = 0.001). The most profound benefit was seen in the Group 1 patients (not reached vs. 40.4 months, p = 0.028). The median OS of patients with mutation-targeted treatments was also significantly longer among Group 2 patients. The median post-NGS survival of patients receiving mutation-targeted treatments was numerically longer in Group 3 and Group 4 patients. In conclusion, mutation-targeted therapy is associated with a favorable outcome. However, the opportunities of NGS-directed treatment and the survival benefits of mutation-targeted treatment were various among different populations.

Intercostal arteriovenous malformations (AVMs) are rare, particularly in congenital cases. We report a 29‐year‐old man with no history of chest trauma who presented with left‐sided chest pain for 3 months. Initial routine contrast‐enhanced chest computed tomography (CT) revealed a pleural mass‐like lesion. Ultrasound‐guided biopsy was initially considered. However, pre‐biopsy chest ultrasound revealed pulsatile vascular flow within the lesion, raising suspicion for a vascular malformation. Subsequent CT angiography (CTA) demonstrated tortuous vessels supplied by multiple intercostal arteries with venous drainage into the intercostal veins and azygos system, confirming a congenital posterior intercostal AVM. Given persistent symptoms and surgical complexity, transarterial embolization with Onyx and N‐butyl cyanoacrylate (NBCA) resulted in marked shunt reduction and symptomatic improvement. This case reminds clinicians to consider intercostal AVMs in the differential diagnosis of pleural‐based lesions and reports our experience with endovascular embolization.

Chronic eosinophilic pneumonia (CEP) is a rare eosinophilic lung disease. We report a 61‐year‐old man with asthma who presented with progressive exertional dyspnoea for 2 months and worsening productive cough for 2 weeks. Peripheral blood eosinophilia was 15% (1314 cells/μL), and chest computed tomography showed bilateral peripheral, upper‐lobe‐predominant opacities. Bronchoalveolar lavage (BAL) revealed marked neutrophil predominance (85%) with only 6% eosinophils. Empirical antibiotics produced no clinical or radiographic improvement. Because clinical and radiological suspicion for CEP remained high despite discordant BAL findings, surgical lung biopsy was performed, demonstrating prominent eosinophilic infiltration with an organizing pneumonia pattern, supporting a diagnosis of CEP. The patient responded well to systemic corticosteroids. This case highlights the role of surgical lung biopsy in suspected CEP with atypical BAL findings and illustrates that organizing pneumonia may occur within the histopathological spectrum of CEP.