Core Needle Lung Biopsy Specimens: Adequacy for <i>EGFR</i> and <i>KRAS</i> Mutational Analysis

Solomon, Stephen B.; Zakowski, Maureen F.; Pao, William; Thornton, Raymond H.; Ladanyi, Marc; Kris, Mark G.; Rusch, Valerie W.; Rizvi, Naiyer A.

doi:10.2214/ajr.09.2858

Cited by 111 publications

(93 citation statements)

References 12 publications

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“…Several studies have assessed the adequacy of needle biopsy specimens for molecular testing, but the results varied with the different study strategies and sample sizes. Solomon et al (30) reported that 89% of needle biopsy specimens acquired using 18-to 20-gauge needles were adequate for EGFR and KRAS sequencing. However, only 18 patients were enrolled in the study.…”

Section: Discussionmentioning

confidence: 99%

CT-guided transthoracic core needle biopsy for small pulmonary lesions: diagnostic performance and adequacy for molecular testing

Tian¹,

Wang²,

Li³

et al. 2017

J. Thorac. Dis.

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Background: Computed tomography (CT)-guided transthoracic needle biopsy is a well-established, minimally invasive diagnostic tool for pulmonary lesions. Few large studies have been conducted on the diagnostic performance and adequacy for molecular testing of transthoracic core needle biopsy (TCNB) for small pulmonary lesions.Methods: This study included CT-guided TCNB with 18-gauge cutting needles in 560 consecutive patients with small (≤3 cm) pulmonary lesions from January 2012 to January 2015. There were 323 males and 237 females, aged 51.8±12.7 years. The size of the pulmonary lesions was 1.8±0.6 cm. The sensitivity, specificity, accuracy and complications of the biopsies were investigated. The risk factors of diagnostic failure were assessed using univariate and multivariate analyses. The sample's adequacy for molecular testing of non-small cell lung cancer (NSCLC) was analyzed.Results: The overall sensitivity, specificity, and accuracy for diagnosis of malignancy were 92.0% (311/338), 98.6% (219/222), and 94.6% (530/560), respectively. The incidence of bleeding complications was 22.9% (128/560), and the incidence of pneumothorax was 10.4% (58/560). Logistic multivariate regression analysis showed that the independent risk factors for diagnostic failure were a lesion size ≤1 cm [odds ratio (OR), 3.95; P=0.007], lower lobe lesions (OR, 2.83; P=0.001), and pneumothorax (OR, 1.98; P=0.004). Genetic analysis was successfully performed on 95.45% (168/176) of specimens diagnosed as NSCLC. At least 96.8% of samples with two or more passes from a lesion were sufficient for molecular testing. Conclusions:The diagnostic yield of small pulmonary lesions by CT-guided TCNB is high, and the procedure is relatively safe. A lesion size ≤1 cm, lower lobe lesions, and pneumothorax are independent risk factors for biopsy diagnostic failure. TCNB specimens could provide adequate tissues for molecular testing.

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Section: Discussionmentioning

confidence: 99%

CT-guided transthoracic core needle biopsy for small pulmonary lesions: diagnostic performance and adequacy for molecular testing

Tian¹,

Wang²,

Li³

et al. 2017

J. Thorac. Dis.

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“…Although the use of smaller biopsy needles can mitigate the risk of post-procedure complications including pneumothorax, hemoptysis, and hemorrhage, that practice could compromise tumour cellularity in the specimen obtained. Although the optimal needle gauge for obtaining core biopsies remains unclear, standard 20-gauge needles are frequently used 36 . Coaxial needle technique permits acquisition of multiple samples and allows for both core biopsy and cytology specimens to be obtained while minimizing pleural punctures and potentially lowering the risk of pneumothorax 37,38 .…”

Section: Interventional Thoracic Radiology Perspectivesmentioning

confidence: 99%

Improving Molecular Testing and Personalized Medicine in Non-Small-Cell Lung Cancer in Ontario

et al. 2017

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“…Because most patients with lung cancer present with advancedstage disease, the information to guide treatment algorithms frequently relies on small biopsy or cytology specimens, such as pleural fluid or fine-needle aspirates. Biopsies with small (18-to 20-gauge) core needles can yield sufficient and reliable samples for genomic testing (48). Similarly, groups have been optimizing techniques for nonsurgical sampling, such as endobronchial ultrasound-guided transbronchial needle aspiration, and mutation assays have been shown to be able to detect somatic mutations from cytology specimens, particularly if cell blocks are available (49,50).…”

Section: Clinical Application For Diagnostic Specimensmentioning

confidence: 99%

The Impact of Genomic Changes on Treatment of Lung Cancer

Cardarella

Johnson

2013

Am J Respir Crit Care Med

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The remarkable success of epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors in patients with EGFR mutations and ALK rearrangements, respectively, introduced the era of targeted therapy in advanced non-small cell lung cancer (NSCLC), shifting treatment from platinum-based combination chemotherapy to molecularly tailored therapy. Recent genomic studies in lung adenocarcinoma identified other potential therapeutic targets, including ROS1 rearrangements, RET fusions, MET amplification, and activating mutations in BRAF, HER2, and KRAS in frequencies exceeding 1%. Lung cancers that harbor these genomic changes can potentially be targeted with agents approved for other indications or under clinical development. The need to generate increasing amounts of genomic information should prompt health-care providers to be mindful of the amounts of tissue needed for these assays when planning diagnostic procedures. In this review, we summarize oncogenic drivers in NSCLC that can be currently detected, highlight their potential therapeutic implications, and discuss practical considerations for successful application of tumor genotyping in clinical decision making.Keywords: lung cancer; cancer genomics; molecular targeted therapy Lung cancer remains the leading cause of cancer-related mortality in the United States and worldwide. Approximately 85% of patients are diagnosed with non-small cell lung cancer (NSCLC), and most present with advanced disease that is not amenable to curative therapy. For these patients, cytotoxic chemotherapy offers modest prolongation in survival. Over the past 2 decades, modifications of chemotherapy combinations, the addition of monoclonal antibodies, including bevacizumab and cetuximab, and the incorporation of histologic subtype into treatment decisions have added incrementally to the survival of patients with advanced NSCLC. However, therapeutic outcomes appear to have reached a plateau, with response rates of 20 to 35% and median survival of 8 to 12 months (1-3). Recently, clinical and laboratory research have led to a better understanding of the molecular pathogenesis that causes lung cancer. The ongoing research of patients with NSCLC and their tumors has demonstrated that NSCLC can be further defined at the molecular level by the identification and characterization of oncogenic drivers that occur in genes critical to cellular proliferation and survival, leading to aberrant activation of signaling proteins that induce sustained growth of the lung cancer cells. These advances in the molecular pathogenesis of NSCLC have prompted investigators to systematically characterize lung cancers for these oncogenic drivers and treat with appropriate targeted therapies. A cohort of patients can now be prospectively identified who have significantly improved outcomes with such therapies, with median survival in excess of 2 years, necessitating the routine identification of these genomically defined patient subsets. In this perspective, we review oncogenic ...

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Core Needle Lung Biopsy Specimens: Adequacy for EGFR and KRAS Mutational Analysis

Cited by 111 publications

References 12 publications

CT-guided transthoracic core needle biopsy for small pulmonary lesions: diagnostic performance and adequacy for molecular testing

CT-guided transthoracic core needle biopsy for small pulmonary lesions: diagnostic performance and adequacy for molecular testing

Improving Molecular Testing and Personalized Medicine in Non-Small-Cell Lung Cancer in Ontario

The Impact of Genomic Changes on Treatment of Lung Cancer

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