Strategic management of transthoracic needle aspirates for histological subtyping and EGFR testing in patients with peripheral lung cancer: An institutional experience

Abstract

We hereby proposed a strategy to maximize biological information retrieval from a limited TTNA specimen in patients with peripheral lung cancer. This algorithm indicated CB preparation for accurate histological subtyping and waste needle washing for molecular testing.

Detection of EGFR and KRAS gene mutations using suspension liquid-based cytology specimens in metastatic lung adenocarcinoma

“…In this study, we did not explore the minimum cells volume for EGFR mutations analysis. One study indicated that even 100–1,000 tumor cells from FNA samples provided reliable results of mutations analysis when sensitive real time PCR method was used [ 16 ]. Another study indicated that the cytological sample with low (10–20%) content of tumor cells was also a sufficient source for EGFR mutation testing in NSCLC patients [ 6 ].…”

Collection and Handling of Thoracic Small Biopsy and Cytology Specimens for Ancillary Studies: Guideline From the College of American Pathologists in Collaboration With the American College of Chest Physicians, Association for Molecular Pathology, American Society of Cytopathology, American Thoracic Society, Pulmonary Pathology Society, Papanicolaou Society of Cytopathology, Society of Interventional Radiology, and Society of Thoracic Radiology

“…The evidence base for this statement comprises 5 studies 41,60,[79][80][81] that evaluated diagnostic yield and adequacy outcomes based on number of passes, 2 studies 41,60 reporting on adverse events of multiple passes, and 8 studies 59,[82][83][84][85][86][87][88] reporting on diagnostic yield and adequacy when a tissue block was created. The aggregate risk of bias across the 13 studies was very serious.…”

“…All studies 41,60,[79][80][81] reporting on diagnostic outcomes suffered from risk of bias in relation to patient selection, 4 studies 41,60,79,80 were limited by detection bias, 4 studies 41,60,79,81 contained missing data, and 2 studies 41,79 did not report on funding source. Of the 8 studies reporting on the creation of tissue blocks, 3 were prospective cohort studies 59,84,87 and 5 were retrospective cohort studies. 82,83,85,86,88 Included studies were limited by their risk of bias in relation to patient selection, 59,[82][83][84][85][86][87][88] performance, 59,85 detection, 59,83,[85][86][87][88] and reporting, 59,[83][84][85][86][87] as well as a lack of reported funding.…”

“…Of the 8 studies reporting on the creation of tissue blocks, 3 were prospective cohort studies 59,84,87 and 5 were retrospective cohort studies. 82,83,85,86,88 Included studies were limited by their risk of bias in relation to patient selection, 59,[82][83][84][85][86][87][88] performance, 59,85 detection, 59,83,[85][86][87][88] and reporting, 59,[83][84][85][86][87] as well as a lack of reported funding. 59,85,86 None of the studies were found to have methodologic flaws that would raise concerns about the findings.…”

“…Combining cytology with a cell block preparation increases diagnostic yield as well as the ability to perform ancillary testing. 84 Based on the systematic literature review, there were several studies that evaluated ancillary testing on cytology cell blocks from transthoracic procedures. A few studies compared success of ancillary testing on cell blocks with surgical pathology specimens, some of which note similar performance rates between cell blocks and surgical core biopsies, 82,84,88 whereas others report lower performance on cell blocks when compared with CNBs.…”