Suitability of Thoracic Cytology for New Therapeutic Paradigms in Non-small Cell Lung Carcinoma: High Accuracy of Tumor Subtyping and Feasibility of EGFR and KRAS Molecular Testing

Rekhtman, Natasha; Brandt, Suzanne M.; Sigel, Carlie S.; Friedlander, M.; Riely, Gregory J.; Travis, William D.; Zakowski, Maureen F.; Moreira, André L.

doi:10.1097/jto.0b013e31820517a3

Cited by 226 publications

(275 citation statements)

References 40 publications

(42 reference statements)

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“…Therefore the optimal assessment of accuracy may in fact be consensus among multiple pathologists. While some experts have suggested that cytology smears may provide greater nuclear and cytoplasmic resolution than histology [25], our results suggest that this is most likely to be achieved through H&E examination and use of IHC staining, rather than simply relying on a smear diagnosis.…”

Section: Limitationsmentioning

confidence: 79%

“…The proportion of NOS as the histologic diagnosis in NSCLC has increased over time, which may be due to increasing use of minimally invasive means to achieve diagnosis [24]. Smallvolume specimens may be paucicellular or have an absence of tissue architecture, making identification of tumour subtype more difficult [25]. Use of IHC stains may potentially overcome …”

Section: Discussionmentioning

confidence: 99%

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Interobserver agreement in determining non-small cell lung cancer subtype in specimens acquired by EBUS-TBNA

et al. 2012

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Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) may diagnose suspected lung cancer. Determination of non-small cell lung cancer (NSCLC) subtype may guide therapy in select patients. Small-volume biopsies may be subject to significant interobserver variability in subtype determination.Three pathologists independently reviewed specimens from 60 patients who underwent EBUS-TBNA for diagnosis/staging of suspected/known NSCLC. Smear, haematoxylin and eosin (H&E) and immunohistochemistry (IHC) specimens were reviewed without reference to other specimen types obtained from the same patient. Final diagnoses, and degree of confidence in the diagnosis, were recorded for each specimen.Almost perfect agreement was seen for distinguishing between small cell lung cancer and NSCLC for all specimen types. Agreement in determination of NSCLC subtype for smear, H&E and IHC specimens was slight (k50.095, 95% CI -0.164-0.355), fair (k50.278, 95% CI 0.075-0.481) and moderate (k50.564, 95% CI 0.338-0.740), respectively. Perfect agreement was seen when all three observers were confident of diagnoses made on IHC specimens.Interobserver agreement in interpretation of EBUS-TBNA specimens is moderate for determination of NSCLC subtype. Agreement is highest following examination of IHC specimens. Clinicians should be aware of the degree of pathologist confidence in the tissue diagnosis prior to commencement of subtype-specific therapy for NSCLC.

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Section: Limitationsmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Interobserver agreement in determining non-small cell lung cancer subtype in specimens acquired by EBUS-TBNA

et al. 2012

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“…In addition, it remains unclear which procedural techniques are superior to others for diagnosis and molecular testing. Although core biopsies have traditionally been thought to be superior to cytological specimens, recent data suggest a 98% success rate for EGFR and KRAS testing on pure cytological specimens with the capability to make a tissue block from fine needle aspirations (FNAs) and thoracentesis [29]. Consequently, decisions related to initial tissue acquisition often involve weighing the risks of performing an invasive procedure more likely to yield adequate tissue versus a less invasive procedure that may be easier and pose less risk for the patient.…”

Section: Challenge: Optimizing Tissue Acquisition and Processingmentioning

confidence: 99%

Molecular Testing for Treatment of Metastatic Non-Small Cell Lung Cancer: How to Implement Evidence-Based Recommendations

et al. 2015

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The recent discovery of relevant biomarkers has reshaped our approach to therapy selection for patients with non-small cell lung cancer.The unprecedented outcomes demonstrated with tyrosine kinase inhibitors in molecularly defined cohorts of patients has underscored the importance of genetic profiling in this disease. Despite published guidelines on biomarker testing, successful tumor genotyping faces significant hurdles at both academic and community-based practices. Oncologists are now faced with interpreting large-scale genomic data from multiple tumor types, possibly making it difficult to stay current with practice standards in lung cancer. In addition, physicians' lack of time, resources, and face-to-face opportunities can interfere with the multidisciplinary approach that is essential to delivery of care. Finally, several challenges exist in optimizing the amount and quality of tissue for molecular testing. Recognizing the importance of biomarker testing, a series of advisory boards were recently convened to address these hurdles and clarify best practices. We reviewed these challenges and established recommendations to help optimize tissue acquisition, processing, and testing within the framework of a multidisciplinary approach. The Oncologist 2015; 20:1175-1181 Implications for Practice: Although several professional societies have incorporated biomarker testing recommendations into clinical practice guidelines for the diagnosis and management of non-small cell lung cancer (NSCLC), health care providers still face considerable challenges when establishing and implementing these standards. Developing and instituting protocols to ensure that all appropriate patients are tested for molecular biomarkers requires communication among the various specialists involved in the care of patients with NSCLC. This report provides insights into key challenges and recommendations for molecular testing of patients with metastatic NSCLC, summarized from a multidisciplinary team of experts spanning academic, community, and integrated health systems.

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“…Several studies have shown that cytological specimens obtained by EBUS-TBNA are suitable for molecular testing for EGFR, Kirsten rat sarcoma viral oncogene homolog (K-ras), and ALK status (14)(15)(16)(17). Optimal use of EBUS-TBNA for lung cancer diagnosis and staging requires a coordinated effort between the bronchoscopist and the cytopathologist to collect and triage specimens for diagnostic testing.…”

Section: Early and Specific Diagnosismentioning

confidence: 99%

An Official American Thoracic Society/European Respiratory Society Statement: The Role of the Pulmonologist in the Diagnosis and Management of Lung Cancer

Gaga¹,

Powell²,

Schraufnagel³

et al. 2013

Am J Respir Crit Care Med

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Suitability of Thoracic Cytology for New Therapeutic Paradigms in Non-small Cell Lung Carcinoma: High Accuracy of Tumor Subtyping and Feasibility of EGFR and KRAS Molecular Testing

Cited by 226 publications

References 40 publications

Interobserver agreement in determining non-small cell lung cancer subtype in specimens acquired by EBUS-TBNA

Interobserver agreement in determining non-small cell lung cancer subtype in specimens acquired by EBUS-TBNA

Molecular Testing for Treatment of Metastatic Non-Small Cell Lung Cancer: How to Implement Evidence-Based Recommendations

An Official American Thoracic Society/European Respiratory Society Statement: The Role of the Pulmonologist in the Diagnosis and Management of Lung Cancer

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