Comparison of Epidermal Growth Factor Receptor Gene Mutations Identified Using Pleural Effusion and Primary Tumor Tissue Samples in Non–Small Cell Lung Cancer

Liu, Nan; Sun, Ruize; Du, Jiang; Dong, Qianze; Fan, Chuifeng; Li, Qingchang; Wang, Enhua; Liu, Yang

doi:10.1097/pai.0000000000000543

Cited by 20 publications

(25 citation statements)

References 24 publications

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“…In the 41 incidences where receptor status or genetic analysis was requested, the pleural fluid specimen was sufficient in 95% (39 out of 41) of cases. Other studies with a focus on this issue have found that pleural fluid samples can reliably provide genetic information that correlates with the primary malignancy [31][32][33][34].…”

Section: Discussionmentioning

confidence: 99%

Investigating unilateral pleural effusions: the role of cytology

Arnold¹,

Fonseka²,

Perry

et al. 2018

Eur Respir J

142

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The vast majority of undiagnosed unilateral pleural effusions have fluid sent for cytological analysis. Despite widespread use, there is uncertainty about its sensitivity to diagnose malignant pleural effusions (MPEs). Our aim was to ascertain the utility of cytology using a large prospective cohort.Consecutive patients presenting with an undiagnosed unilateral pleural effusion were recruited to this UK-based study. All had pleural fluid sent for cytological analysis. Cytological sensitivity was based on the final diagnosis at 12 months, confirmed by two consultants.Over 8 years, 921 patients were recruited, of which 515 had a MPE. Overall sensitivity of fluid cytology to diagnose malignancy was 46% (95% CI 42–58%). There was variation in sensitivity depending on cancer primary, with mesothelioma (6%) and haematological malignancies (40%) being significantly lower than adenocarcinomas (79%). MPEs secondary to ovarian cancer had high pick-up rates (95%). In asbestos-exposed males with exudative effusions, the risk of MPE was 60%, but cytological sensitivity was 11%.This is the largest prospective study of pleural fluid cytology and informs discussions with patients about the likely requirement for investigations following thoracentesis. In patients presenting with a clinical suspicion of mesothelioma, cytological sensitivity is low, so more definitive investigations could be performed sooner.

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Section: Discussionmentioning

confidence: 99%

Investigating unilateral pleural effusions: the role of cytology

Arnold¹,

Fonseka²,

Perry

et al. 2018

Eur Respir J

142

View full text Add to dashboard Cite

show abstract

“…In the 41 incidences where receptor status or genetic analysis was requested, the pleural fluid specimen was sufficient in 95% of cases (39/41). Other studies with a focus on this issue have found that pleural fluid samples can reliably provide genetic information that correlates with the primary malignancy [31][32][33][34].…”

Section: Characteristics Of Cytology Diagnostic Versus Non-diagnosticmentioning

confidence: 99%

Investigating unilateral pleural effusions: the role of cytology.

Arnold

Fonseka

Perry

et al. 2018

Pleural and Mediastinal Malignancies

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“… 62 Moreover, the concordance between the primary tumor and pleural metastases concerning mutational alterations is very high. 63 Therefore, PF samples (CBs, smears, cytospins or liquid-based cytology) are considered suitable alternatives to tissue biopsy for molecular studies, provided they are not paucicellular. 64 , 65 The adequacy of specimens for molecular testing should be determined by assessing cancer-cell content and deoxyribonucleic acid (DNA) quantity and quality.…”

Section: Biomarkers Of Malignant Effusionsmentioning

confidence: 99%

Biomarkers in the diagnosis of pleural diseases: a 2018 update

Porcel

2018

Ther Adv Respir Dis

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The use of biomarkers on pleural fluid (PF) specimens may assist the decision-making process and enhance clinical diagnostic pathways. Three paradigmatic examples are heart failure, tuberculosis and, particularly, malignancy. An elevated PF concentration of the amino-terminal fragment of probrain natriuretic peptide (>1500 pg/ml) is a hallmark of acute decompensated heart failure. Adenosine deaminase, interferon-γ and interleukin-27 are three valuable biomarkers for diagnosing tuberculous pleurisy, yet only the first has been firmly established in clinical practice. Diagnostic PF biomarkers for malignancy can be classified as soluble-protein based, immunocytochemical and nucleic-acid based. Soluble markers (e.g. carcinoembryonic antigen (CEA), carbohydrate antigen 15–3, mesothelin) are only indicative of cancer, but not confirmatory. Immunocytochemical studies on PF cell blocks allow: (a) to distinguish mesothelioma from reactive mesothelial proliferations (e.g. loss of BAP1 nuclear expression, complemented by the demonstration of p16 deletion using fluorescence in situ hybridization, indicate mesothelioma); (b) to separate mesothelioma from adenocarcinoma (e.g. calretinin, CK 5/6, WT-1 and D2-40 are markers of mesothelioma, whereas CEA, EPCAM, TTF-1, napsin A, and claudin 4 are markers of carcinoma); and (c) to reveal tumor origin in pleural metastases of an unknown primary site (e.g. TTF-1 and napsin A for lung adenocarcinoma, p40 for squamous lung cancer, GATA3 and mammaglobin for breast cancer, or synaptophysin and chromogranin A for neuroendocrine tumors). Finally, PF may provide an adequate sample for analysis of molecular markers to guide patients with non-small cell lung cancer to appropriate targeted therapies. Molecular testing must include, at least, mutations of epidermal growth-factor receptor and BRAF V600E, translocations of rat osteosarcoma and anaplastic lymphoma kinase, and expression of programmed death ligand 1.

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Comparison of Epidermal Growth Factor Receptor Gene Mutations Identified Using Pleural Effusion and Primary Tumor Tissue Samples in Non–Small Cell Lung Cancer

Cited by 20 publications

References 24 publications

Investigating unilateral pleural effusions: the role of cytology

Investigating unilateral pleural effusions: the role of cytology

Investigating unilateral pleural effusions: the role of cytology.

Biomarkers in the diagnosis of pleural diseases: a 2018 update

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