FNA, core biopsy, or both for the diagnosis of lung carcinoma: Obtaining sufficient tissue for a specific diagnosis and molecular testing

Abstract

BACKGROUND Increasingly, minimally invasive procedures are performed to assess lung lesions and stage lung carcinomas. In cases of advanced‐stage lung cancer, the biopsy may provide the only diagnostic tissue. The aim of this study was to determine which method—fine‐needle aspiration (FNA), core biopsy (CBx), or both (B)—is optimal for providing sufficient tissue for rendering a specific diagnosis and pursuing molecular studies for guiding tumor‐specific treatment. METHODS A search was performed for computed tomography–guided lung FNA, CBx, or B cases with rapid onsite evaluation. Carcinomas were assessed for the adequacy to render a specific diagnosis; this was defined as enough refinement to subtype a primary carcinoma or to assess a metastatic origin morphologically and/or immunohistochemically. In cases of primary lung adenocarcinoma, the capability of each modality to yield sufficient tissue for molecular studies (epidermal growth factor receptor, KRAS, or anaplastic lymphoma kinase) was also assessed. RESULTS There were 210 cases, and 134 represented neoplasms, including 115 carcinomas. For carcinomas, a specific diagnosis was reached in 89% of FNA cases (33 of 37), 98% of CBx cases (43 of 44), and 100% of B cases (34 of 34). For primary lung adenocarcinomas, adequate tissue remained to perform molecular studies in 94% of FNA cases (16 of 17), 100% of CBx cases (19 of 19), and 86% of B cases (19 of 22). No statistical difference was found among the modalities for either reaching a specific diagnosis (p = .07, Fisher exact test) or providing sufficient tissue for molecular studies (p = .30, Fisher exact test). CONCLUSIONS The results suggest that FNA, CBx, and B are comparable for arriving at a specific diagnosis and having sufficient tissue for molecular studies: they specifically attained the diagnostic and prognostic goals of minimally invasive procedures for lung carcinoma. Cancer (Cancer Cytopathol) 2015;123:318–26. © 2015 American Cancer Society.

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

“…However, only 18 patients were enrolled in the study. Coley et al (31) reported that 100% of needle biopsy tissues remained adequate to perform molecular studies. Similarly, only 19 cases underwent needle biopsy in this study.…”

Yield and Clinical Utility of Next-Generation Sequencing in Selected Patients With Lung Adenocarcinoma

“…All internal testing performed on fine needle aspiration specimens was performed on cell blocks as previously described. [13][14][15] ROSE was performed for fine needle aspirations by smears and core needle biopsies by touch imprints. and select rearrangements) were determined and then reported for each patient sample.…”

Use of Exfoliative Specimens and Fine-Needle Aspiration Smears for Mutation Testing in Lung Adenocarcinoma

“…[17] . Although cell blocks are the most commonly used cytologic preparation followed by direct smears [18,19] , concordant re- sults have been obtained using cell blocks and FNA smears with same failure rates [20][21][22][23] . Direct FNA smears are preferred over other cytological preparations due to the concurrent morphological evaluation and the selection of areas for tumor enrichment [24] .…”