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Roy-Chowdhuri S. Molecular Pathology of Lung Cancer. Clin Lab Med 2024; 44:137-147. [PMID: 38821637 DOI: 10.1016/j.cll.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
The identification of targetable genomic alterations in lung cancer is required as standard of care to guide optimal therapy selection. With a constantly evolving landscape of ancillary molecular and biomarker testing in lung cancer, pathologists need to be aware of what specimens to test, how the testing should be performed, and which targets to test for to provide the clinically relevant genomic information necessary to treat these patients. Several guideline statements on the topic are currently available to help pathologists and laboratory personnel best use the small specimens obtained from patients with lung cancer for ancillary molecular testing.
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Affiliation(s)
- Sinchita Roy-Chowdhuri
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard Unit 83, Houston, TX 77030, USA.
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2
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Navani N, Butler R, Ibrahimo S, Verma A, Evans M, Doherty GJ, Ahmed S. Optimising tissue acquisition and the molecular testing pathway for patients with non-small cell lung cancer: A UK expert consensus statement. Lung Cancer 2022; 172:142-153. [PMID: 36099709 DOI: 10.1016/j.lungcan.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 11/21/2022]
Abstract
Targeted therapy against actionable variants has revolutionised the treatment landscape for non-small cell lung cancer (NSCLC). Approximately half of NSCLC adenocarcinomas have an actionable variant, making molecular testing a critical component of the diagnostic process to personalise therapeutic options, optimise clinical outcomes and minimise toxicity. Recently, genomic testing in England has undergone major changes with the introduction of Genomic Laboratory Hubs, designed to consolidate and enhance existing laboratory provision and deliver genomic testing as outlined in the National Genomic Test Directory. Similar changes are ongoing in Scotland, Wales and Northern Ireland. However, multiple challenges exist with current tissue acquisition procedures and the molecular testing pathway in the UK, including quantity and quality of available tissue, adequacy rates, test availability among genomic laboratories, turnaround times, multidisciplinary team communication, and limited guidance and standardisation. The COVID-19 pandemic has added an extra layer of complexity. Herein, we summarise best practice recommendations, based on expert opinion, to overcome existing challenges in the UK. The least invasive biopsy technique should be undertaken with the aim of acquiring the greatest quality and quantity of tissue. Use of sedation should be considered to improve patient experience. Rapid on-site evaluation may also be useful to help guide adequate sampling, and liquid biopsy may be beneficial in some instances. Sample processing should be appropriate to facilitate biomarker testing, in particular, next-generation sequencing for comprehensive genomic information. Steps to optimise tissue utilisation and turnaround times, such as planning of tissue usage, limiting immunohistochemistry, tumour enrichment, and reflex testing at diagnosis, should be implemented. Guidelines for tissue acquisition and sample processing may help to improve sample adequacy to perform downstream testing. Communication among genomic laboratories will help to standardise test availability across England and local auditing could identify further areas for optimisation, including ways to improve turnaround times and adequacy rates.
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Affiliation(s)
- Neal Navani
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom.
| | - Rachel Butler
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital, London, United Kingdom
| | | | | | - Matthew Evans
- Black Country Pathology Services, West Midlands, United Kingdom
| | - Gary J Doherty
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Samreen Ahmed
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
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3
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Ye F, Yang Y, Liu J. Comparison of High-Frequency Contrast-Enhanced Ultrasound With Conventional High-Frequency Ultrasound in Guiding Pleural Lesion Biopsy. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1420-1428. [PMID: 35504789 DOI: 10.1016/j.ultrasmedbio.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/24/2022] [Accepted: 03/10/2022] [Indexed: 06/14/2023]
Abstract
The goal of the work described here was to compare high-frequency contrast-enhanced ultrasound (HF-CEUS) and conventional high-frequency ultrasound (HFU) with respect to performance and safety during ultrasound-guided biopsy of pleural lesions. We performed a retrospective study on patients with pleural lesions who received the puncture biopsy under the guidance of conventional HFU or HF-CEUS between August 2018 and August 2021. These patients received either a conventional HF-U (HF-U group) or HF-CEUS (HF-CEUS group) examination. Clinical characteristics, pathological results, ultrasonic images and complications were compared between these two groups. A total of 144 patients were enrolled, with 70 in the HFU group and 74 in the HF-ECUS group. Except for the time required for ultrasonic localization (p < 0.05), there were no significant differences in clinical characteristics between the two groups. The success rate of biopsy in the HF-CEUS group was higher than that in the HFU group (93.2% vs. 81.4%, p < 0.05). There were significant differences between the two groups in terms of measurements of pleural thickness, necrotic areas, large blood vessels and lesion boundaries (p < 0.05). The complication rates were 2.7% and 12.9% in the HF-CEUS and HFU groups, respectively, with a significant difference (p < 0.05). Compared with conventional HFU, the HF-CEUS-guided pleural biopsy had a better success rate and fewer complications. HF-CEUS could facilitate the biopsy in patients with pleural lesions.
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Affiliation(s)
- Fuyong Ye
- First Affiliated Hospital of Jinan University, Guangzhou, China; Department of Medical Ultrasound, Gaozhou People's Hospital, Gaozhou, Guangdong, China
| | - Yuwen Yang
- First Affiliated Hospital of Jinan University, Guangzhou, China; Department of Medical Ultrasound, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Jianhua Liu
- First Affiliated Hospital of Jinan University, Guangzhou, China; Department of Medical Ultrasound, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China.
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Wittrup KD, Kaufman HL, Schmidt MM, Irvine DJ. Intratumorally anchored cytokine therapy. Expert Opin Drug Deliv 2022; 19:725-732. [PMID: 35638290 DOI: 10.1080/17425247.2022.2084070] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION On-target, off-tumor toxicity severely limits systemic dosing of cytokines and agonist antibodies for cancer. Intratumoral administration is increasingly being explored to mitigate this problem. Full exploitation of this mode of administration must include a mechanism for sustained retention of the drug; otherwise, rapid diffusion out of the tumor eliminates any advantage. AREAS COVERED We focus here on strategies for anchoring immune agonists in accessible formats. Such anchoring may utilize extracellular matrix components, cell surface receptor targets, or exogenously administered particulate materials. Promising alternative strategies not reviewed here include slow release from the interior of a material depot, expression following local transfection, and conditional proteolytic activation of masked molecules. EXPERT OPINION An effective mechanism for tissue retention is a critical component of intratumorally anchored cytokine therapy, as leakage leads to decreased tumor drug exposure and increased systemic toxicity. Matching variable drug release kinetics with receptor-mediated cellular uptake is an intrinsic requirement for the alternative strategies mentioned above. Bioavailability of an anchored form of the administered drug is key to obviating this balancing act.
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Affiliation(s)
- K Dane Wittrup
- Koch Institute for Integrative Cancer Research at the Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | | | - Darrell J Irvine
- Koch Institute for Integrative Cancer Research at the Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.,Howard Hughes Medical Institute, MD, USA
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Elsakka A, Petre EN, Ridouani F, Ghosn M, Bott MJ, Husta BC, Arcila ME, Alexander E, Solomon SB, Ziv E. Percutaneous Image-Guided Biopsy for a Comprehensive Hybridization Capture-Based Next-Generation Sequencing in Primary Lung Cancer: Safety, Efficacy, and Predictors of Outcome. JTO Clin Res Rep 2022; 3:100342. [PMID: 35711720 PMCID: PMC9194869 DOI: 10.1016/j.jtocrr.2022.100342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction To evaluate factors associated with successful comprehensive genomic sequencing of image-guided percutaneous needle biopsies in patients with lung cancer using a broad hybrid capture-based next-generation sequencing assay (CHCA). Methods We conducted a single-institution retrospective review of image-guided percutaneous transthoracic needle biopsies from January 2018 to December 2019. Samples with confirmed diagnosis of primary lung cancer and for which CHCA had been attempted were identified. Pathologic, clinical data and results of the CHCA were reviewed. Covariates associated with CHCA success were tested for using Fisher's exact test or Wilcoxon ranked sum test. Logistic regression was used to identify factors independently associated with likelihood of CHCA success. Results CHCA was requested for 479 samples and was successful for 433 (91%), with a median coverage depth of 659X. Factors independently associated with lower likelihood of CHCA success included small tumor size (OR = 0.26 [95% confidence interval (CI): 0.11-0.62, p = 0.002]), intraoperative inadequacy on cytologic assessment (OR = 0.18 [95% CI: 0.06-0.63, p = 0.005]), small caliber needles (≥20-gauge) (OR = 0.22 [95% CI: 0.10-0.45, p < 0.001]), and presence of lung parenchymal abnormalities (OR = 0.12 [95% CI: 0.05-0.25, p < 0.001]). Pneumothorax requiring chest tube insertion occurred in 6% of the procedures. No grade IV complications or procedure-related deaths were reported. Conclusions Percutaneous image-guided transthoracic needle biopsy is safe and has 91% success rate for CHCA in primary lung cancer. Intraoperative inadequacy, small caliber needle, presence of parenchymal abnormalities, and small tumor size (≤1 cm) are independently associated with likelihood of failure.
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Affiliation(s)
- Ahmed Elsakka
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
- Body Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elena N. Petre
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Fourat Ridouani
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mario Ghosn
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Matthew J. Bott
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bryan C. Husta
- Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Maria E. Arcila
- Molecular Diagnostics Service, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Erica Alexander
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen B. Solomon
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Etay Ziv
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
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Kong F, Li Y, Guo R, Yang L, Di J, He L, Wang Z, Liu D, Li X. Liquid biopsy assay for pulmonary adenocarcinoma using supernatants from
core‐needle
biopsy specimens. Thorac Cancer 2022; 13:1822-1826. [PMID: 35575062 PMCID: PMC9200882 DOI: 10.1111/1759-7714.14461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 04/23/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022] Open
Abstract
Background Genomic testing is the cornerstone of the treatment of patients with non‐small‐cell lung cancer. However, comprehensive molecular testing of small specimens may be inadequate due to limited tissue. Liquid biopsy has emerged as a new method of genotyping. In this study, we evaluate the feasibility of using supernatants from core needle biopsy samples of lung adenocarcinoma for genomic testing. Methods Core needle biopsy specimens and their supernatants were collected from patients (n = 48) with lung adenocarcinoma. Genomic testing results of the supernatant samples were compared with results derived from paired tissue samples from the same patient. Result All 48 supernatant samples yield adequate cell‐free DNA, but the concentration of cell‐free RNA did not meet the criteria for analysis. The concordance rate between the genomic testing results of supernatants and the corresponding tissue samples was 95.8% (kappa = 0.899). The coincidence rate of detectable mutations at the DNA level in the supernatants was up to 100%. Conclusion Core needle biopsy supernatants can provide a valuable specimen source for genotyping pulmonary adenocarcinoma. However, the method of preserving and extracting RNA from supernatant specimens needs further improvement.
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Affiliation(s)
- Fanlei Kong
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine Chinese Academy of Medicine Sciences Beijing China
- Graduate School of Peking Union Medical College Chinese Academy of Medical Sciences Beijing China
| | - Yuanming Li
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine Chinese Academy of Medicine Sciences Beijing China
| | - Runqi Guo
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine Chinese Academy of Medicine Sciences Beijing China
| | - Li Yang
- Department of Pathology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing China
| | - Jing Di
- Department of Pathology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing China
| | - Lei He
- Department of Pathology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing China
| | - Zheng Wang
- Department of Pathology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing China
| | - Dongge Liu
- Department of Pathology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing China
| | - Xiaoguang Li
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine Chinese Academy of Medicine Sciences Beijing China
- Graduate School of Peking Union Medical College Chinese Academy of Medical Sciences Beijing China
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Deboever N, Feldman HA, Hofstetter WL, Mehran RJ, Rajaram R, Rice DC, Roth JA, Sepesi B, Swisher SG, Vaporciyan AA, Walsh GL, Antonoff MB. The Role of Surgery in the Treatment of Melanoma Pulmonary Metastases in the Modern Era. J Surg Res 2022; 277:125-130. [PMID: 35489217 DOI: 10.1016/j.jss.2022.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/09/2022] [Accepted: 04/08/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The lung represents a frequent site of spread for metastatic melanoma, which has historically been managed with surgical resection achieving promising outcomes. We hypothesized that the role of surgery in the management of melanoma pulmonary metastases (MPM) is evolving among the development of less invasive diagnostic and novel systemic therapeutic strategies. MATERIALS AND METHODS A single-center thoracic surgery database was reviewed and patients who underwent surgical resection of MPM between 1998 and 2019 were identified. Demographic, clinicopathologic, and surgical data were collected and analyzed, as were the annual volumes and indications for surgical resection. A Cochran-Armitage test was used to assess the trend in surgical indication. RESULTS Three hundred and seventy seven surgical procedures for MPM were performed during the years of study in the care of 347 patients. Patients were predominantly male, with a mean age of 59.3 y. The mean number of annual resections was 17 and while this number initially increased from six in 1998 to a peak of 39 cases in 2008, a decline was subsequently observed. Diagnostic resection decreased from 22% in 1998-1999 to 5% at the peak of procedures in 2008-2009 and to 0 in 2018-2019 (P = 0.02). Curative resection increased from 44% in 1998-1999 to 73% in 2008-2009 (P < 0.001) and remained the dominant reason for surgery in later years. CONCLUSIONS Surgical indications in the management of MPM have transformed in conjunction with systemic modalities, and the volume of resections has decreased in the modern era. Despite innovations in systemic management and shifting goals of operative interventions, surgeons continue to play a vital role in caring for these patients with an advanced disease.
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Affiliation(s)
- Nathaniel Deboever
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hope A Feldman
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Reza J Mehran
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ravi Rajaram
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David C Rice
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jack A Roth
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen G Swisher
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ara A Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Garrett L Walsh
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Ghosn M, Cheema W, Zhu A, Livschitz J, Maybody M, Boas FE, Santos E, Kim D, Beattie JA, Offin M, Rusch VW, Zauderer MG, Adusumilli PS, Solomon SB. Image-guided interventional radiological delivery of chimeric antigen receptor (CAR) T cells for pleural malignancies in a phase I/II clinical trial. Lung Cancer 2022; 165:1-9. [PMID: 35045358 PMCID: PMC9256852 DOI: 10.1016/j.lungcan.2022.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/14/2021] [Accepted: 01/03/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES We describe techniques and results of image-guided delivery of mesothelin-targeted chimeric antigen receptor (CAR) T cells in patients with pleural malignancies in a phase I/II trial (ClinicalTrials.gov: NCT02414269). MATERIALS AND METHODS Patients without a pleural catheter or who lack effusion for insertion of a catheter (31 of 41) were administered intrapleural CAR T cells by interventional radiologists under image guidance by computed tomography or ultrasound. CAR T cells were administered through a needle in an accessible pleural loculation (intracavitary) or following an induced loculated artificial pneumothorax. In patients where intracavitary infusion was not feasible, CAR T cells were injected via percutaneous approach either surrounding and/or in the pleural nodule/thickening (intratumoral). Pre- and post-procedural clinical, laboratory, and imaging findings were assessed. RESULTS CAR T cells were administered intrapleurally in 31 patients (33 procedures, 2 patients were administered a second dose) with successful delivery of planned dose (10-186 mL); 14/33 (42%) intracavitary and 19/33 (58%) intratumoral. All procedures were completed within 2 h of T-cell thawing. There were no procedure-related adverse events greater than grade 1 (1 in 3 patients had prior ipsilateral pleural fusion procedures). The most common imaging finding was ground glass opacities with interlobular septal thickening and/or consolidation, observed in 12/33 (36%) procedures. There was no difference in the incidence of fever, CRP, IL-6, and peak vector copy number in the peripheral blood between infusion methods. CONCLUSION Image-guided intrapleural delivery of CAR T cells using intracavitary or intratumoral routes is feasible, repeatable and safe across anatomically variable pleural cancers.
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Affiliation(s)
- Mario Ghosn
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - Waseem Cheema
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - Amy Zhu
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - Jennifer Livschitz
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - Majid Maybody
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - Franz E Boas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - Ernesto Santos
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - DaeHee Kim
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - Jason A Beattie
- Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - Michael Offin
- Thoracic Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - Valerie W Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - Marjorie G Zauderer
- Thoracic Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA; Cellular Therapeutics Center, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - Prasad S Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA; Cellular Therapeutics Center, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA; Center For Cell Engineering, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA.
| | - Stephen B Solomon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
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Iguchi T, Matsui Y, Tomita K, Uka M, Umakoshi N, Munetomo K, Hiraki T. CT fluoroscopy-guided biopsy of pulmonary lesions contacting the interlobar fissure: An analysis of 72 biopsies. Diagn Interv Imaging 2022; 103:302-309. [PMID: 35144888 DOI: 10.1016/j.diii.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate retrospectively the safety and diagnostic yield of computed tomography (CT) fluoroscopy-guided biopsy for pulmonary lesions with interlobar fissure contact. MATERIALS AND METHODS Seventy-two lesions showing interlobar fissure contact (mean size, 15.2 ± 5.3 [SD] mm [range: 5.3-27.0 mm]; mean length of interlobar fissure contact, 8.9 ± 3.6 [SD] mm [range: 2.6-17.5 mm] in 72 patients (33 men, 39 women; mean age, 69.7 ± 10.3 [SD] years; age range: 37-91 years) were evaluated. Multiple variables were assessed to determine the risk factors for diagnostic failure and pneumothorax. Additionally, these variables were compared between these 72 lesions and randomly selected controls (i.e., non-contact lesions). RESULTS All biopsies were technically successful using the transfissural (n = 14) or conventional routes (the route into the lung lobe with the target) with (n = 35) or without (n = 23) possible risk of needle insertion into the interlobar fissure after penetrating the target lesion. Sixty-eight (94.4%) procedures succeeded diagnostically and four (5.6%) failed. There were 27 grade I pneumothorax (37.5%), one (1.4%) grade II bleeding, and five (6.9%) grade IIIa pneumothorax requiring chest tube placement. Groups with and without pneumothorax did not differ significantly in patient-, lesion-, or procedure-related variables. Diagnostic yields and pneumothorax occurrence showed no significant differences between lesions with interlobar fissure contact and controls. CONCLUSION CT fluoroscopy-guided biopsy of pulmonary lesions with interlobar fissure contact is a safe procedure with a high diagnostic yield. Furthermore, because of potential complications, the transfissural route should be used only when a safer route is not possible.
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Affiliation(s)
- Toshihiro Iguchi
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho kita-ku, Okayama 700-8558, Japan; Department of Radiological Technology, Okayama University Graduate School of Health Sciences, Okayama 700-8558, Japan.
| | - Yusuke Matsui
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho kita-ku, Okayama 700-8558, Japan
| | - Koji Tomita
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho kita-ku, Okayama 700-8558, Japan
| | - Mayu Uka
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho kita-ku, Okayama 700-8558, Japan
| | - Noriyuki Umakoshi
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho kita-ku, Okayama 700-8558, Japan
| | - Kazuaki Munetomo
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho kita-ku, Okayama 700-8558, Japan
| | - Takao Hiraki
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho kita-ku, Okayama 700-8558, Japan
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Weinfurtner K, Cho J, Ackerman D, Chen JX, Woodard A, Li W, Ostrowski D, Soulen MC, Dagli M, Shamimi-Noori S, Mondschein J, Sudheendra D, Stavropoulos SW, Reddy S, Redmond J, Khaddash T, Jhala D, Siegelman ES, Furth EE, Hunt SJ, Nadolski GJ, Kaplan DE, Gade TPF. Variability in biopsy quality informs translational research applications in hepatocellular carcinoma. Sci Rep 2021; 11:22763. [PMID: 34815453 PMCID: PMC8611010 DOI: 10.1038/s41598-021-02093-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/18/2021] [Indexed: 12/19/2022] Open
Abstract
In the era of precision medicine, biopsies are playing an increasingly central role in cancer research and treatment paradigms; however, patient outcomes and analyses of biopsy quality, as well as impact on downstream clinical and research applications, remain underreported. Herein, we report biopsy safety and quality outcomes for percutaneous core biopsies of hepatocellular carcinoma (HCC) performed as part of a prospective clinical trial. Patients with a clinical diagnosis of HCC were enrolled in a prospective cohort study for the genetic, proteomic, and metabolomic profiling of HCC at two academic medical centers from April 2016 to July 2020. Under image guidance, 18G core biopsies were obtained using coaxial technique at the time of locoregional therapy. The primary outcome was biopsy quality, defined as tumor fraction in the core biopsy. 56 HCC lesions from 50 patients underwent 60 biopsy events with a median of 8 core biopsies per procedure (interquartile range, IQR, 7–10). Malignancy was identified in 45/56 (80.4%, 4 without pathology) biopsy events, including HCC (40/56, 71.4%) and cholangiocarcinoma (CCA) or combined HCC-CCA (5/56, 8.9%). Biopsy quality was highly variable with a median of 40% tumor in each biopsy core (IQR 10–75). Only 43/56 (76.8%) and 23/56 (41.1%) samples met quality thresholds for genomic or metabolomic/proteomic profiling, respectively, requiring expansion of the clinical trial. Overall and major complication rates were 5/60 (8.3%) and 3/60 (5.0%), respectively. Despite uniform biopsy protocol, biopsy quality varied widely with up to 59% of samples to be inadequate for intended purpose. This finding has important consequences for clinical trial design and highlights the need for quality control prior to applications in which the presence of benign cell types may substantially alter findings.
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Affiliation(s)
- Kelley Weinfurtner
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA, USA.,Penn Image-Guided Interventions Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - Joshua Cho
- Penn Image-Guided Interventions Laboratory, University of Pennsylvania, Philadelphia, PA, USA.,Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel Ackerman
- Penn Image-Guided Interventions Laboratory, University of Pennsylvania, Philadelphia, PA, USA.,Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - James X Chen
- Vascular & Interventional Specialists of Charlotte Radiology, Charlotte, NC, USA
| | - Abashai Woodard
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Wuyan Li
- Penn Image-Guided Interventions Laboratory, University of Pennsylvania, Philadelphia, PA, USA.,Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - David Ostrowski
- Penn Image-Guided Interventions Laboratory, University of Pennsylvania, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael C Soulen
- Division of Interventional Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Mandeep Dagli
- Division of Interventional Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Susan Shamimi-Noori
- Division of Interventional Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey Mondschein
- Division of Interventional Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Deepak Sudheendra
- Division of Interventional Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Shilpa Reddy
- Division of Interventional Radiology, University of Pennsylvania, Philadelphia, PA, USA.,Corporal Michael J Cresenz VA Medical Center, Philadelphia, PA, USA
| | - Jonas Redmond
- Division of Interventional Radiology, University of Pennsylvania, Philadelphia, PA, USA.,Corporal Michael J Cresenz VA Medical Center, Philadelphia, PA, USA
| | - Tamim Khaddash
- Division of Interventional Radiology, University of Pennsylvania, Philadelphia, PA, USA.,Corporal Michael J Cresenz VA Medical Center, Philadelphia, PA, USA
| | - Darshana Jhala
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Evan S Siegelman
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Emma E Furth
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen J Hunt
- Penn Image-Guided Interventions Laboratory, University of Pennsylvania, Philadelphia, PA, USA.,Division of Interventional Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory J Nadolski
- Penn Image-Guided Interventions Laboratory, University of Pennsylvania, Philadelphia, PA, USA.,Corporal Michael J Cresenz VA Medical Center, Philadelphia, PA, USA
| | - David E Kaplan
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA, USA.,Penn Image-Guided Interventions Laboratory, University of Pennsylvania, Philadelphia, PA, USA.,Corporal Michael J Cresenz VA Medical Center, Philadelphia, PA, USA
| | - Terence P F Gade
- Penn Image-Guided Interventions Laboratory, University of Pennsylvania, Philadelphia, PA, USA. .,Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA. .,Division of Interventional Radiology, University of Pennsylvania, Philadelphia, PA, USA. .,Corporal Michael J Cresenz VA Medical Center, Philadelphia, PA, USA. .,Radiology and Cancer Biology, University of Pennsylvania Perelman School of Medicine, 652 BRB II/III, 421 Curie Blvd, Philadelphia, PA, 19104-6160, USA.
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11
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Nam BD, Yoon SH, Hong H, Hwang JH, Goo JM, Park S. Tissue Adequacy and Safety of Percutaneous Transthoracic Needle Biopsy for Molecular Analysis in Non-Small Cell Lung Cancer: A Systematic Review and Meta-analysis. Korean J Radiol 2021; 22:2082-2093. [PMID: 34564960 PMCID: PMC8628152 DOI: 10.3348/kjr.2021.0244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/11/2021] [Accepted: 06/07/2021] [Indexed: 12/01/2022] Open
Abstract
Objective We conducted a systematic review and meta-analysis of the tissue adequacy and complication rates of percutaneous transthoracic needle biopsy (PTNB) for molecular analysis in patients with non-small cell lung cancer (NSCLC). Materials and Methods We performed a literature search of the OVID-MEDLINE and Embase databases to identify original studies on the tissue adequacy and complication rates of PTNB for molecular analysis in patients with NSCLC published between January 2005 and January 2020. Inverse variance and random-effects models were used to evaluate and acquire meta-analytic estimates of the outcomes. To explore heterogeneity across the studies, univariable and multivariable meta-regression analyses were performed. Results A total of 21 studies with 2232 biopsies (initial biopsy, 8 studies; rebiopsy after therapy, 13 studies) were included. The pooled rates of tissue adequacy and complications were 89.3% (95% confidence interval [CI]: 85.6%–92.6%; I2 = 0.81) and 17.3% (95% CI: 12.1%–23.1%; I2 = 0.89), respectively. These rates were 93.5% and 22.2% for the initial biopsies and 86.2% and 16.8% for the rebiopsies, respectively. Severe complications, including pneumothorax requiring chest tube placement and massive hemoptysis, occurred in 0.7% of the cases (95% CI: 0%–2.2%; I2 = 0.67). Multivariable meta-regression analysis showed that the tissue adequacy rate was not significantly lower in studies on rebiopsies (p = 0.058). The complication rate was significantly higher in studies that preferentially included older adults (p = 0.001). Conclusion PTNB demonstrated an average tissue adequacy rate of 89.3% for molecular analysis in patients with NSCLC, with a complication rate of 17.3%. PTNB is a generally safe and effective diagnostic procedure for obtaining tissue samples for molecular analysis in NSCLC. Rebiopsy may be performed actively with an acceptable risk of complications if clinically required.
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Affiliation(s)
- Bo Da Nam
- Department of Radiology, Soonchunhyang University College of Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Soon Ho Yoon
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiology, UMass Memorial Medical Center, Worcester, MA, USA.
| | - Hyunsook Hong
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
| | - Jung Hwa Hwang
- Department of Radiology, Soonchunhyang University College of Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Suyeon Park
- Department of Biostatistics and Data Innovation, Soonchunhyang University Seoul Hospital, Seoul, Korea
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12
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Limaye S. Synchronized Tissue Acquisition Techniques for Novel Biomarker Discovery: Are You Ready to Waltz? JOURNAL OF IMMUNOTHERAPY AND PRECISION ONCOLOGY 2021; 4:168-169. [PMID: 35663103 PMCID: PMC9138434 DOI: 10.36401/jipo-21-x3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 05/01/2023]
Affiliation(s)
- Sewanti Limaye
- Department of Medical Oncology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
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13
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Abstract
The identification of targetable genomic alterations in lung cancer is required as standard of care to guide optimal therapy selection. With a constantly evolving landscape of ancillary molecular and biomarker testing in lung cancer, pathologists need to be aware of what specimens to test, how the testing should be performed, and which targets to test for to provide the clinically relevant genomic information necessary to treat these patients. Several guideline statements on the topic are currently available to help pathologists and laboratory personnel best use the small specimens obtained from patients with lung cancer for ancillary molecular testing.
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Affiliation(s)
- Sinchita Roy-Chowdhuri
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard Unit 83, Houston, TX 77030, USA.
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14
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Iguchi T, Hiraki T, Matsui Y, Tomita K, Uka M, Tanaka T, Munetomo K, Gobara H, Kanazawa S. CT-guided biopsy of lung nodules with pleural contact: Comparison of two puncture routes. Diagn Interv Imaging 2021; 102:539-544. [PMID: 34099434 DOI: 10.1016/j.diii.2021.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/15/2021] [Accepted: 05/18/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE The purpose of this study was to retrospectively compare two puncture routes (transpleural vs. transpulmonary) for computed tomography (CT) fluoroscopy-guided cutting needle biopsy of lung nodules with pleural contact. PATIENTS AND METHODS A total of 102 patients (72 men; mean age, 71.1±9.5 [SD] years) were included and 102 biopsies of 102 lung nodules (mean size, 16.7±5.9 [SD] mm; range, 6.0-29.4mm; mean length of pleural contact, 10.1±4.2 [SD] mm; range, 2.8-19.6mm) were analyzed. All procedures were classified as biopsies via the direct transpleural route or the transpulmonary route. The patient-, lesion-, and biopsy-related variables, diagnostic yields, and incidence of complications were compared between the two routes. RESULTS Biopsy was performed via the direct transpleural route (n=59; 57.8%) and transpulmonary route (n=43; 42.2%). In the transpulmonary route group, the mean distance of the intrapulmonary pathway was 17.7±9.4 [SD] mm (range: 4.1-47.6mm; P<0.001) and the introducer needle trajectory angle of<45° was significantly observed (8.5% [5/59] vs. 60.5% [26/43]; P<0.001). There was no significant difference in diagnostic accuracy between the direct transpleural and transpulmonary routes (93.2% [55/59] vs. 90.7% [39/43]; P=0.718). The frequencies of all complications (64.4% [38/59] vs. 97.7% [42/43]; P<0.001), pneumothorax (33.9% [20/59] vs. 65.1% [28/43]; P=0.003), pneumothorax with chest tube placement (3.4% [2/59] vs. 18.6% [8/43]; P=0.016), and pulmonary hemorrhage (47.5% [28/59] vs. 76.7% [33/43]; P=0.004) were significantly lower in the direct transpleural group. CONCLUSION Direct transpleural route is recommended for CT fluoroscopy-guided biopsy of lung nodules with pleural contact because it is safer and yields similar diagnostic accuracy than transpulmonary route.
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Affiliation(s)
- Toshihiro Iguchi
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, 700-8558 Okayama, Japan.
| | - Takao Hiraki
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, 700-8558 Okayama, Japan
| | - Yusuke Matsui
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, 700-8558 Okayama, Japan
| | - Koji Tomita
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, 700-8558 Okayama, Japan
| | - Mayu Uka
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, 700-8558 Okayama, Japan
| | - Takashi Tanaka
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, 700-8558 Okayama, Japan
| | - Kazuaki Munetomo
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, 700-8558 Okayama, Japan
| | - Hideo Gobara
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, 700-8558 Okayama, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, 700-8558 Okayama, Japan
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15
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Faber E, Grosu H, Sabir S, San Lucas FA, Barkoh BA, Bassett RL, Luthra R, Stewart J, Roy-Chowdhuri S. Adequacy of small biopsy and cytology specimens for comprehensive genomic profiling of patients with non-small-cell lung cancer to determine eligibility for immune checkpoint inhibitor and targeted therapy. J Clin Pathol 2021; 75:612-619. [PMID: 33952592 DOI: 10.1136/jclinpath-2021-207597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 11/03/2022]
Abstract
AIMS In advanced-stage non-small-cell lung cancer (NSCLC), incomplete genotyping for guideline-recommended genomic biomarkers poses a significant challenge to making informed and timely clinical decisions. We report our institution's experience in assessing the adequacy of small specimens for comprehensive genomic profiling for guideline-recommended lung cancer biomarker testing. METHODS We performed a retrospective evaluation of all image-guided procedures for NSCLC performed in our institution between October 2016 and July 2018, including core needle biopsy (CNB) and fine-needle aspiration (FNA) in patients who had undergone genomic profiling for lung cancer. Lung cancer biomarker adequacy, defined as successful testing of guideline-recommended biomarkers including, epidermal growth factor receptor (EGFR); serine/threonine protein kinase B-Raf (BRAF); anaplastic lymphoma kinase (ALK); proto-oncogene tyrosine protein kinase ROS (ROS1); Rearranged during Transfection (RET); Tyrosine protein kinase Met (MET); and programmed cell death ligand 1 (PD-L1), was evaluated. RESULTS A total of 865 cases were evaluated in this study, 785 of which included testing of all lung cancer biomarkers. Lung tissue was adequate for biomarker testing in 84% of cases; this rate increased to 87% when biomarker testing was combined with concurrently acquired FNA or CNB specimens. Biomarker testing success correlated strongly with DNA concentration (p<0.0001) and the use of 22G needles in endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) procedures (p=0.0035). Biomarker testing of CNB specimens showed a significantly higher success rate than did biomarker testing of cytology FNA specimens (p=0.0005). The adequacy of EBUS-TBNA samples was not significantly different from that of the transthoracic needle aspiration samples (p=0.40). Variables such as age, gender, lesion size, site, diagnosis and number of needle passes showed no significant correlation with success rates in lung cancer biomarker testing. CONCLUSION The growing numbers of therapeutic biomarkers in NSCLC requires judicious triage of limited-volume tissue from small specimens. Our study showed that thoracic small tissue specimens can be used successfully to provide prognostic and predictive information for the current guideline-recommended biomarkers for NSCLC in most cases.
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Affiliation(s)
- Erin Faber
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Horiana Grosu
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sharjeel Sabir
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Francis Anthony San Lucas
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Bedia A Barkoh
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Roland L Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rajyalakshmi Luthra
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - John Stewart
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sinchita Roy-Chowdhuri
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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16
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Xu M, Tapia C, Hajjar J, Sabir S, Colen R, Nagarajan P, Aung PP, Gong J, Rodon J, Fu S, Stephen B, Roy-Chowdhuri S, Le H, Yang V, Zarifa A, Abdelsalam ME, Jhingran A, Javle M, Pant S, Carter B, Milton DR, Sun R, Karp DD, Koay EJ, Yang Y, Wistuba II, Hwu P, Meric-Bernstam F, Naing A. Implementation of a Novel Web-Based Lesion Selection Tool to Improve Acquisition of Tumor Biopsy Specimens. JOURNAL OF IMMUNOTHERAPY AND PRECISION ONCOLOGY 2021; 4:45-52. [PMID: 35663531 DOI: 10.36401/jipo-21-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/14/2021] [Accepted: 03/17/2021] [Indexed: 12/17/2022]
Abstract
Introduction For maximum utility of molecular characterization by next-generation sequencing (NGS) and better understanding of tumor microenvironment with immune correlates analysis, biopsy specimens must yield adequate tumor tissue, and sequential biopsy specimens should sample a consistent site. We developed a web-based lesion selection tool (LST) that enables management and tracking of the biopsy specimen collections. Methods Of 145 patients, the LST was used for 88 patients; the other 57 served as controls. We evaluated consistency of the lesion biopsied in longitudinal collections, number of cores obtained, and cores with adequate tumor cellularity for NGS. The Fisher exact test and Wilcoxon rank sum test were used to identify differences between the groups. Results The analysis included 30 of 88 (34%) patients in the LST group and 52 of 57 (91%) in the control group. The LST workflow ensured 100% consistency in the lesions biopsied compared with 75% in the control group in longitudinal collections and increased the proportion of patients in whom at least five cores were collected per biopsy. Conclusions The novel LST platform facilitates coordination, performance, and management of longitudinal biopsy specimens. Use of the LST enables sampling of the designated lesion consistently, which is likely to accurately inform us the effect of the treatment on tumor microenvironment and evolution of resistant pathways. Such studies are important translational component of any clinical trials and research as they guide the development of next line of therapy, which has significant effect on clinical utility. However, validation of this approach in a larger study is warranted.
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Affiliation(s)
- Mingxuan Xu
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Coya Tapia
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joud Hajjar
- Section of Immunology, Allergy and Rheumatology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Sharjeel Sabir
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rivka Colen
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Priyadharsini Nagarajan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Phyu P Aung
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jing Gong
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jordi Rodon
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Siqing Fu
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bettzy Stephen
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sinchita Roy-Chowdhuri
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hung Le
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vincent Yang
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Abdulrazzak Zarifa
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mohamed Elsayed Abdelsalam
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anuja Jhingran
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Milind Javle
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shubham Pant
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brett Carter
- Section of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Denai R Milton
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ryan Sun
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Daniel D Karp
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eugene Jon Koay
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yali Yang
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ignacio I Wistuba
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Patrick Hwu
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Funda Meric-Bernstam
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Aung Naing
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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17
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Pneumothorax Rate and Diagnostic Adequacy of Computed Tomography-guided Lung Nodule Biopsies Performed With 18 G Versus 20 G Needles: A Cross-Sectional Study. J Thorac Imaging 2021; 35:265-269. [PMID: 32032253 DOI: 10.1097/rti.0000000000000481] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE Conflicting data exist with regard to the effect of needle gauge on outcomes of computed tomography (CT)-guided lung nodule biopsies. The purpose of this study was to compare the complication and diagnostic adequacy rates between 2 needle sizes: 18 G and 20 G in CT-guided lung nodule biopsies. MATERIALS AND METHODS This retrospective cohort study examined CT-guided lung biopsies performed between March 2014 and August 2016 with a total of 550 patients between the ages of 30 and 94. Biopsies were performed using an 18-G or a 20-G needle. Procedure-associated pneumothorax and other complication rates were compared between the 2 groups. Univariate and multiple logistic regression analyses were performed. RESULTS There was no significant difference in pneumothorax rate between 18 G (n=125) versus 20 G (n=425) (rates: 25.6% vs. 28.7%; P=0.50; odds ratio [OR]=0.86; 95% confidence interval [CI]=0.54-1.35), chest tube insertion rate (4.8% vs. 5.6%; P=0.71; OR=0.84; 95% CI=0.34-2.11), or diagnostic adequacy (95% vs. 93%; P=0.36; OR=1.51; 95% CI=0.61-3.72). Multiple logistic regression analysis demonstrated emphysema along the biopsy path (OR=3.12; 95% CI=1.63-5.98) and nodule distance from the pleural surface ≥4 cm (OR=1.85; 95% CI=1.05-3.28) to be independent risk factors for pneumothorax. CONCLUSION No statistically significant difference in pneumothorax rate or diagnostic adequacy was found between 18-G versus 20-G core biopsy needles. Independent risk factors for pneumothorax include emphysema along the biopsy path and nodule distance from the pleural surface.
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18
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Hu H, Li C, Lv T, Li H, Hu Y, Shen Q, Mino-Kenudson M, Bertolaccini L, Rocco G, Zarogoulidis P, Zhang F, Lin D, Liu H, Song Y. Contrast-enhanced computed tomography prior to percutaneous transthoracic needle biopsy reduces the incidence of hemorrhage. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:288. [PMID: 33708915 PMCID: PMC7944326 DOI: 10.21037/atm-20-4384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Hemorrhage is the second most common complication of percutaneous transthoracic needle biopsy (PTNB), and at present, there is no effective prevention strategy. Contrast-enhanced computed tomography (CECT) has the advantage of clearly visualizing blood supply within the lesion and aiding in the imaging of blood vessels, which can reduce hemorrhage complicating PTNB. As no large-sample studies were evaluating whether CECT could reduce hemorrhage, we conducted the present retrospective study. Methods From November 2011 to February 2016, 1,282 biopsies at Jinling Hospital were retrospectively reviewed; 555 underwent CECT, and 727 underwent non-contrast computed tomography (CT). Factors associated with hemorrhage were defined, and hemorrhage rates were compared between the 2 groups. Results We found that pre-biopsy CECT was associated with a reduced incidence of biopsy-related hemorrhage compared to non-contrast CT (16.4% vs. 23.1%, P=0.003). Propensity score matching (PSM) analysis also showed that the incidence of hemorrhage in the CECT group was lower than that of the non-contrast CT group at a ratio of 1:1 (P=0.039), 1:2 (P=0.028), or 1:3 (P=0.013). In the multivariate analysis, CECT before PTNB was found to be significantly associated with a reduced risk of hemorrhage [odds ratio (OR): 0.671, 95% confidence interval (CI): 0.499–0.902, P=0.008]. Puncture position, lesion size, depth of needle tract, and the number of punctures were also found to be associated with hemorrhage (all P<0.05). Conclusions Compared with non-contrast CT, CECT significantly reduced the risk of post-biopsy pulmonary hemorrhage, which suggests that CECT should be performed before PTNB.
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Affiliation(s)
- Huan Hu
- Department of Respiratory Medicine, Suzhou Hospital Affiliated Nanjing Medical University, Suzhou, China
| | - Chuling Li
- Department of Respiratory Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Tangfeng Lv
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Huijuan Li
- Department of Respiratory Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Yangbo Hu
- Department of Respiratory Medicine, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Qin Shen
- Department of Pathology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Luca Bertolaccini
- Division of Thoracic Surgery IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gaetano Rocco
- Department of Thoracic Surgery and Oncology, National Cancer Institute, Pascale Foundation, Naples, Italy
| | - Pavlos Zarogoulidis
- Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Fang Zhang
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Dang Lin
- Department of Respiratory Medicine, Suzhou Hospital Affiliated Nanjing Medical University, Suzhou, China
| | - Hongbing Liu
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Yong Song
- Department of Respiratory Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China.,Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
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Sheth RA, Baerlocher MO, Connolly BL, Dariushnia SR, Shyn PB, Vatsky S, Tam AL, Gupta S. Society of Interventional Radiology Quality Improvement Standards on Percutaneous Needle Biopsy in Adult and Pediatric Patients. J Vasc Interv Radiol 2020; 31:1840-1848. [DOI: 10.1016/j.jvir.2020.07.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 12/13/2022] Open
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20
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The value of interventional radiology in clinical trial teams: experience from the BATTLE lung cancer trials. Clin Radiol 2020; 76:155.e25-155.e34. [PMID: 33268083 DOI: 10.1016/j.crad.2020.09.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/30/2020] [Indexed: 11/22/2022]
Abstract
AIM To report on the multidisciplinary approach, focusing specifically on the role of the interventional radiologist (IR), used to support the Biomarker-integrated Approaches of Targeted Therapy for Lung Cancer Elimination (BATTLE) and BATTLE-2 trials. MATERIALS AND METHODS Patients who underwent percutaneous image-guided biopsy for the BATTLE and BATTLE-2 trials were reviewed. A radiology-based, three-point, lesion-scoring system was developed and used by two IRs. Lesions were given a score of 3 (most likely to yield sufficient material for biomarker analysis) if they met the following criteria: size >2 cm, solid mass, demonstrated imaging evidence of viability, and were technically easy to sample. Lesions not meeting all four criteria were scored 2 with the missing criteria noted as negative factors. Lesions considered to have risks that outweighed potential benefits receive a score of 1 and were not biopsied. Univariate and multivariate analyses were performed to evaluate the score's ability to predict successful yield for biomarker adequacy. RESULTS A total of 555 biopsies were performed. The overall yield for analysis of the required biomarkers was 86.1% (478/555), and 84% (268/319) and 88.9% (210/236) for BATTLE and BATTLE-2, respectively (p=0.09). Lesions receiving a score of 3 were adequate for biomarker analysis in 89% of cases. Lesions receiving a score of 2 with more than two negative factors were adequate for molecular analysis in 69.2% (IR1, p=0.03) and 74% (IR2, p=0.04) of cases. The two IRs scored 78.4% of the lesions the same indicating moderate agreement (kappa=0.55; 95% confidence interval [CI]: 0.48, 0.61). CONCLUSIONS IRs add value to clinical trial teams by optimising lesions selected for biopsy and biomarker analysis.
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O'Shea A, Tam AL, Kilcoyne A, Flaherty KT, Lee SI. Image-guided biopsy in the age of personalised medicine: strategies for success and safety. Clin Radiol 2020; 76:154.e1-154.e9. [PMID: 32896425 DOI: 10.1016/j.crad.2020.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/04/2020] [Indexed: 12/28/2022]
Abstract
Oncology has progressed into an era of personalised medicine, whereby the therapeutic regimen is tailored to the molecular profile of the patient's cancer. Determining personalised therapeutic options is achieved by using tumour genomics and proteomics to identify the specific molecular targets against which candidate drugs can interact. Several dozen targeted drugs, many for multiple cancer types are already widely in clinical use. Molecular profiling of tumours is contingent on high-quality biopsy specimens and the most common method of tissue sampling is image-guided biopsy. Thus, for radiologists performing these biopsies, the paradigm has now shifted away from obtaining specimens simply for histopathological diagnosis to acquiring larger amounts of viable tumour cells for DNA, RNA, or protein analysis. These developments have highlighted the central role now played by radiologists in the delivery of personalised cancer care. This review describes the principles of molecular profiling assays and biopsy techniques for optimising yield, and describes a scoring system to assist in patient selection for percutaneous biopsy.
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Affiliation(s)
- A O'Shea
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA, 02114, USA.
| | - A L Tam
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - A Kilcoyne
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - K T Flaherty
- Department of Medicine, Division of Oncology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - S I Lee
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA, 02114, USA
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Hannigan B, Ye W, Mehrotra M, Lam V, Bolivar A, Zalles S, Barkoh BA, Duose D, Hu PC, Broaddus R, Stewart J, Heymach J, Medeiros LJ, Wistuba I, Luthra R, Roy-Chowdhuri S. Liquid biopsy assay for lung carcinoma using centrifuged supernatants from fine-needle aspiration specimens. Ann Oncol 2020; 30:963-969. [PMID: 30887015 DOI: 10.1093/annonc/mdz102] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Tumor mutation profiling is standard-of-care in lung carcinoma patients. However, comprehensive molecular profiling of small specimens, including core needle biopsy (CNB) and fine-needle aspiration (FNA) specimens, may often be inadequate due to limited tissue. Centrifuged FNA supernatants, which are typically discarded, have emerged recently as a novel liquid-based biopsy for molecular testing. In this study, we evaluate the use of lung carcinoma FNA supernatants for detecting clinically relevant mutations. METHODS Supernatants from lung carcinoma FNA samples (n = 150) were evaluated. Samples were further analyzed using next-generation sequencing (NGS) and ultrasensitive droplet digital PCR (ddPCR). Mutation profiles in a subset of samples were compared with results derived from paired tissue samples from the same patient (n = 67) and available plasma liquid biopsy assay (n = 45). RESULTS All 150 samples yielded adequate DNA and NGS were carried out successfully on 104 (90%) of 116 selected samples. Somatic mutations were detected in 82% of the samples and in 50% of these patients a clinically relevant mutation was identified that would qualify them for targeted therapy or a clinical trial. There was high overall concordance between the mutation profiles of supernatants and the corresponding tissue samples, with 100% concordance with concurrent FNA and 96% with concurrent CNB samples. Comparison of actionable driver mutations detected in supernatant versus plasma samples showed 84% concordance. CONCLUSIONS FNA supernatants can provide a valuable specimen source for genotyping lung carcinoma especially in patients with insufficient tumor tissue, thereby reducing multigene mutation profiling failure rates, improving turnaround times, and avoiding repeat biopsies.
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Affiliation(s)
- B Hannigan
- Graduate Program in Diagnostic Genetics, School of Health Professions
| | - W Ye
- Graduate Program in Diagnostic Genetics, School of Health Professions
| | - M Mehrotra
- Departments of Hematopathology, Division of Pathology and Laboratory Medicine
| | - V Lam
- Thoracic/Head and Neck Medical Oncology
| | - A Bolivar
- Graduate Program in Diagnostic Genetics, School of Health Professions
| | - S Zalles
- Graduate Program in Diagnostic Genetics, School of Health Professions
| | - B A Barkoh
- Departments of Hematopathology, Division of Pathology and Laboratory Medicine
| | - D Duose
- Translational Molecular Pathology, Division of Pathology and Laboratory Medicine
| | - P C Hu
- Graduate Program in Diagnostic Genetics, School of Health Professions
| | - R Broaddus
- Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J Stewart
- Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J Heymach
- Thoracic/Head and Neck Medical Oncology
| | - L J Medeiros
- Departments of Hematopathology, Division of Pathology and Laboratory Medicine
| | - I Wistuba
- Translational Molecular Pathology, Division of Pathology and Laboratory Medicine
| | - R Luthra
- Departments of Hematopathology, Division of Pathology and Laboratory Medicine
| | - S Roy-Chowdhuri
- Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA.
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Roy-Chowdhuri S. A new guideline from the College of American Pathologists to improve the adequacy of thoracic small specimens for ancillary studies. Cancer Cytopathol 2020; 128:690-692. [PMID: 32520433 DOI: 10.1002/cncy.22299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/12/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Sinchita Roy-Chowdhuri
- Division of Pathology and Laboratory Medicine, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Lee SH, Kim EY, Kim T, Chang YS. Compared to plasma, bronchial washing fluid shows higher diagnostic yields for detecting EGFR-TKI sensitizing mutations by ddPCR in lung cancer. Respir Res 2020; 21:142. [PMID: 32517757 PMCID: PMC7281949 DOI: 10.1186/s12931-020-01408-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/26/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The rate of diagnosis of advanced lung adenocarcinoma must be improved. In this study, we compared the detection rates of EGFR-tyrosine kinase inhibitor-sensitizing mutations (mEGFRs) in bronchial washing fluid (BWF) and the plasma of patients with lung adenocarcinoma using the tissue genotype as the standard reference. METHODS Paired blood and BWF specimens were collected from 73 patients with lung cancer. The tumor EGFR mutation status was determined by genotyping of the plasma and BWF samples using droplet digital PCR (ddPCR). RESULTS The study cohort included 26, 10, 10, and 27 patients with stage I, II, III, and IV disease. Of the 73 cases, 35 had a wild-type EGFR, and 19 had the L858R substitution and exon 19 deletion mutations. The areas under the receiver operator characteristic curves for sensitivity vs. specificity of ddPCR were 0.895 [95% confidence interval (CI): 0.822-0.969] for BWF and 0.686 (95% CI: 0.592-0.780) for plasma (p < 0.001). The fractional abundance was higher in BWF of the mEGFR-positive cases than in the plasma (p = 0.004), facilitating easy threshold setting and discrimination between mEGFR-positive and negative cases. When genotyping results obtained using plasma and BWF were compared for early lung cancer (stages I-IIIA), the diagnostic yields were significantly higher for BWF ddPCR, and the same tendency was observed for the advanced stages, suggesting that the BWF data may reflect the genotype status in early-stage patients. CONCLUSIONS The mEGFR genotyping results obtained using BWF showed a higher diagnostic efficacy than did those obtained using the plasma. Thus, BWF-based genotyping may be a useful substitute for that using plasma in lung cancer.
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Affiliation(s)
- Sang Hoon Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Young Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Taehee Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoon Soo Chang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Roy-Chowdhuri S, Dacic S, Ghofrani M, Illei PB, Layfield LJ, Lee C, Michael CW, Miller RA, Mitchell JW, Nikolic B, Nowak JA, Pastis NJ, Rauch CA, Sharma A, Souter L, Billman BL, Thomas NE, VanderLaan PA, Voss JS, Wahidi MM, Yarmus LB, Gilbert CR. 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. Arch Pathol Lab Med 2020; 144:933-958. [PMID: 32401054 DOI: 10.5858/arpa.2020-0119-cp] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The need for appropriate specimen use for ancillary testing has become more commonplace in the practice of pathology. This, coupled with improvements in technology, often provides less invasive methods of testing, but presents new challenges to appropriate specimen collection and handling of these small specimens, including thoracic small biopsy and cytology samples. OBJECTIVE.— To develop a clinical practice guideline including recommendations on how to obtain, handle, and process thoracic small biopsy and cytology tissue specimens for diagnostic testing and ancillary studies. METHODS.— The College of American Pathologists convened an expert panel to perform a systematic review of the literature and develop recommendations. Core needle biopsy, touch preparation, fine-needle aspiration, and effusion specimens with thoracic diseases including malignancy, granulomatous process/sarcoidosis, and infection (eg, tuberculosis) were deemed within scope. Ancillary studies included immunohistochemistry and immunocytochemistry, fluorescence in situ hybridization, mutational analysis, flow cytometry, cytogenetics, and microbiologic studies routinely performed in the clinical pathology laboratory. The use of rapid on-site evaluation was also covered. RESULTS.— Sixteen guideline statements were developed to assist clinicians and pathologists in collecting and processing thoracic small biopsy and cytology tissue samples. CONCLUSIONS.— Based on the systematic review and expert panel consensus, thoracic small specimens can be handled and processed to perform downstream testing (eg, molecular markers, immunohistochemical biomarkers), core needle and fine-needle techniques can provide appropriate cytologic and histologic specimens for ancillary studies, and rapid on-site cytologic evaluation remains helpful in appropriate triage, handling, and processing of specimens.
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Affiliation(s)
- Sinchita Roy-Chowdhuri
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Sanja Dacic
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Mohiedean Ghofrani
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Peter B Illei
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Lester J Layfield
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Christopher Lee
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Claire W Michael
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Ross A Miller
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Jason W Mitchell
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Boris Nikolic
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Jan A Nowak
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Nicholas J Pastis
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Carol Ann Rauch
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Amita Sharma
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Lesley Souter
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Brooke L Billman
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Nicole E Thomas
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Paul A VanderLaan
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Jesse S Voss
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Momen M Wahidi
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Lonny B Yarmus
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
| | - Christopher R Gilbert
- From the Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (Dr Gilbert); the Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Dr Illei); the Department of Pathology and Anatomic Sciences, University of Missouri, Columbia (Dr Layfield); the Department of Radiology, Keck Medical Center of the University of Southern California, Los Angeles (Dr Lee); the Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Michael); Memorial Pathology Consultants, PA, Houston, Texas (Dr Miller); the Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida (Dr Mitchell); the Department of Interventional and Vascular Radiology, Cooley Dickinson Hospital, Northampton, Massachusetts (Dr Nikolic); the Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York (Dr Nowak); the Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston (Dr Pastis); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rauch); the Department of Radiology, Massachusetts General Hospital, Boston (Dr Sharma); the Methodology Consultant, Ontario, Canada (Dr Souter); the Departments of Governance Services (Ms Billman) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr VanderLaan); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Mr Voss); the Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, North Carolina (Dr Wahidi); and the Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Yarmus)
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Levy EB, Fiel MI, Hamilton SR, Kleiner DE, McCall SJ, Schirmacher P, Travis W, Kuo MD, Suh RD, Tam AL, Islam SU, Ferry-Galow K, Enos RA, Doroshow JH, Makhlouf HR. State of the Art: Toward Improving Outcomes of Lung and Liver Tumor Biopsies in Clinical Trials-A Multidisciplinary Approach. J Clin Oncol 2020; 38:1633-1640. [PMID: 32134701 DOI: 10.1200/jco.19.02322] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE National Cancer Institute (NCI)-sponsored clinical trial network studies frequently require biopsy specimens for pharmacodynamic and molecular biomarker analyses, including paired pre- and post-treatment samples. The purpose of this meeting of NCI-sponsored investigators was to identify local institutional standard procedures found to ensure quantitative and qualitative specimen adequacy. METHODS NCI convened a conference on best biopsy practices, focusing on the clinical research community. Topics discussed were (1) criteria for specimen adequacy in the personalized medicine era, (2) team-based approaches to ensure specimen adequacy and quality control, and (3) risk considerations relevant to academic and community practitioners and their patients. RESULTS AND RECOMMENDATIONS Key recommendations from the convened consensus panel included (1) establishment of infrastructure for multidisciplinary biopsy teams with a formalized information capture process, (2) maintenance of standard operating procedures with regular team review, (3) optimization of tissue collection and yield methodology, (4) incorporation of needle aspiration and other newer techniques, and (5) commitment of stakeholders to use of guideline documents to increase awareness of best biopsy practices, with the goal of universally improving tumor biopsy practices.
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Affiliation(s)
- Elliot B Levy
- Center for Interventional Oncology, Radiology and Imaging Sciences and Center for Cancer Research, National Institutes of Health, Bethesda, MD
| | - Maria I Fiel
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Stanley R Hamilton
- Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David E Kleiner
- Laboratory of Pathology, National Institutes of Health, Bethesda, MD
| | | | - Peter Schirmacher
- Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - William Travis
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Michael D Kuo
- Department of Radiology Medical Artificial Intelligence Laboratory Initiative, The University of Hong Kong, Hong Kong
| | - Robert D Suh
- Department of Radiological Sciences, Ronald Reagan UCLA Medical Center, Los Angeles, CA
| | - Alda L Tam
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, TX
| | - Shaheen U Islam
- Division of Pulmonary, Critical Care & Sleep Medicine, Medical College of Georgia, Augusta University, Augusta, GA
| | - Katherine Ferry-Galow
- Laboratory of Human Toxicology and Pharmacology, Applied/ Developmental Research Support Directorate, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD
| | | | - James H Doroshow
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - Hala R Makhlouf
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
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Iguchi T, Hiraki T, Matsui Y, Mitsuhashi T, Komaki T, Okamoto S, Fukuma S, Tomita K, Uka M, Kanazawa S. Difference in specimen weights with semi-automatic cutting biopsy needles. Jpn J Radiol 2020; 38:579-586. [PMID: 32124166 DOI: 10.1007/s11604-020-00935-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/16/2020] [Indexed: 01/25/2023]
Abstract
PURPOSE To assess specimen weight difference of six types of semi-automatic cutting biopsy needles. MATERIALS AND METHODS We compared 18- and 20-gauge needles, one aspiration-type (STARCUT® aspiration-type, TSK Laboratory, Tochigi, Japan) and five non-aspiration-type (MISSION®, BARD, AZ; SuperCore™, Argon Medical Devices, TX; Temno Evolution®, Care Fusion, IL; FINE CORE®, Toray Medical, Tokyo, Japan; Quick-Core®, Cook, IN) needles. Four biopsies were performed with each needle with the longest throw length on an excised bovine liver. The biopsies were repeated with new needles, four times with four different livers. STARCUT® was used both with and without aspiration. RESULTS Sixteen specimens were obtained with each needle. In needles of gauges, STARCUT® with aspiration provided the heaviest specimen and significantly heavier specimens were obtained with STARCUT® with aspiration (P < 0.05) than five non-aspiration-type needles. The specimen weight differed significantly (P < 0.001) among all 18- and 20-gauge needles. The specimen weights did not differ significantly between aspiration and non-aspiration biopsies with STARCUT® (6.32 vs. 5.97 mg with 18-gauge needle, P = 0.342; 1.95 vs. 1.92 mg with 20-gauge needle, P = 0.886). CONCLUSION Although STARCUT® with aspiration provided the heaviest specimen, specimen weights were not significantly different between aspiration and non-aspiration biopsies. We assessed the specimen weight difference of six types of semi-automatic cutting biopsy needles. Significantly heavier specimens were obtained with STARCUT® with aspiration than the other needles. The specimen weight differed significantly among all 18- and 20-gauge needles but did not differ significantly between aspiration and non-aspiration biopsies with STARCUT®.
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Affiliation(s)
- Toshihiro Iguchi
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan.
| | - Takao Hiraki
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan
| | - Yusuke Matsui
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan
| | - Toshiharu Mitsuhashi
- Center for Innovative Clinical Medicine, Okayama University Hospital, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan
| | - Toshiyuki Komaki
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan
| | - Soichiro Okamoto
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan
| | - Shogo Fukuma
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan
| | - Koji Tomita
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan
| | - Mayu Uka
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan
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Chen L, Jing H, Gong Y, Tam AL, Stewart J, Staerkel G, Guo M. Diagnostic efficacy and molecular testing by combined fine-needle aspiration and core needle biopsy in patients with a lung nodule. Cancer Cytopathol 2020; 128:201-206. [PMID: 31913583 DOI: 10.1002/cncy.22234] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 11/07/2019] [Accepted: 12/12/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Combined image-guided fine-needle aspiration biopsy (FNA) and core needle biopsy (CNB) has become the standard of care for diagnosis and/or molecular testing for patients with a solitary lung nodule at our institution. Our purpose was to evaluate the efficacy of this practice. METHODS We identified patients who underwent combined lung FNA/CNB during 2012 at our institution. A total of 667 patients who underwent 682 combined lung FNA/CNB procedures were included in the study, including 355 men and 312 women. Combined lung FNA/CNB procedures were performed by a radiologist. The adequacy of FNA specimens was assessed immediately by a cytopathologist. The FNA and CNB specimens were interpreted separately by a cytopathologist and a surgical pathologist, respectively. The diagnostic accuracy of the combined technique was determined. RESULTS The rate of diagnostic consistency between FNA and CNB was 83.4%, and the rate of diagnostic accuracy for malignancy was 98.5% for combined FNA/CNB. Combined FNA/CNB showed a high diagnostic efficacy for malignancy (sensitivity, 97.6%; specificity, 100%). Combined FNA/CNB had a lower false-negative rate for malignancy (2.2%) than either FNA (7.2%) or CNB (6.2%) alone. FNA contributed to 10.3% of molecular analyses as a complementary tissue source. CONCLUSIONS Combined lung FNA/CNB has high diagnostic efficacy for malignancy and a lower false-negative rate than either procedure alone. FNA was a valuable complement to CNB for molecular testing, potentially reducing patient inconvenience and morbidity associated with repeated lung needle biopsy.
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Affiliation(s)
- Lan Chen
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - He Jing
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yun Gong
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alda L Tam
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John Stewart
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gregg Staerkel
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ming Guo
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Preoperative biopsy and tumor recurrence of stage I adenocarcinoma of the lung. Surg Today 2019; 50:673-684. [PMID: 31873771 DOI: 10.1007/s00595-019-01941-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 11/24/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE To evaluate whether preoperative biopsy affects the outcomes of patients undergoing at least lobectomy for stage I lung adenocarcinoma. METHODS We reviewed the medical records of patients who underwent surgery for stage I lung adenocarcinoma between 2006 and 2013. Tumor recurrence and survival were compared between patients who underwent preoperative biopsy, including computed tomographic-guided needle biopsy and transbronchial biopsy, and those who underwent intraoperative frozen section. RESULTS Among 509 patients, 229 patients (44.9%) underwent preoperative biopsy and 280 patients had lung adenocarcinoma diagnosed by intraoperative frozen section (reference group). Recurrence developed in 65 (12.8%) patients within a median follow-up period of 54.4 months. Multivariate analysis demonstrated that preoperative biopsy (OR 1.97, p = 0.045), radiological solid appearance (OR 5.43, p < 0.001), and angiolymphatic invasion (OR 2.48, p = 0.010) were independent predictors of recurrence. In the overall cohort, preoperative biopsy appeared to worsen 5-year disease-free and overall survival significantly (76.6% vs. 93.0%, p < 0.001; and 83.8% vs. 94.5%, p = 0.002, respectively) compared with the reference group. After propensity matching, multivariable logistic regression still identified preoperative biopsy as an independent predictor of overall recurrence (OR 2.21, p = 0.048) after adjusting for tumor characteristics. CONCLUSION Preoperative biopsy might be considered a prognosticator of recurrence of stage I adenocarcinoma of the lungs in patients who undergo at least anatomic lobectomy without postoperative adjuvant chemotherapy.
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Fintelmann FJ, Troschel FM, Kuklinski MW, McDermott S, Petranovic M, Digumarthy SR, Sharma A, Troschel AS, Price MC, Hariri LP, Gilman MD, Shepard JO, Sequist LV, Piotrowska Z. Safety and Success of Repeat Lung Needle Biopsies in Patients with Epidermal Growth Factor Receptor-Mutant Lung Cancer. Oncologist 2019; 24:1570-1576. [PMID: 31152082 PMCID: PMC6975961 DOI: 10.1634/theoncologist.2019-0158] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 05/07/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Postprogression repeat biopsies are critical in caring for patients with lung cancer with epidermal growth factor receptor (EGFR) mutations. However, hesitation about invasive procedures persists. We assessed safety and tissue adequacy for molecular profiling among repeat postprogression percutaneous transthoracic needle aspirations and biopsies (rebiopsies). MATERIALS AND METHODS All lung biopsies performed at our hospital from 2009 to 2017 were reviewed. Complications were classified by Society of Interventional Radiology criteria. Complication rates between rebiopsies in EGFR-mutants and all other lung biopsies (controls) were compared using Fisher's exact test. Success of molecular profiling was recorded. RESULTS During the study period, nine thoracic radiologists performed 107 rebiopsies in 75 EGFR-mutant patients and 2,635 lung biopsies in 2,347 patients for other indications. All biopsies were performed with computed tomography guidance, coaxial technique, and rapid on-site pathologic evaluation (ROSE). The default procedure was to take 22-gauge fine-needle aspirates (FNA) followed by 20-gauge tissue cores. Minor complications occurred in 9 (8.4%) rebiopsies and 503 (19.1%; p = .004) controls, including pneumothoraces not requiring chest tube placement (4 [3.7%] vs. 426 [16.2%] in rebiopsies and controls, respectively; p < .001). The only major complication was pneumothorax requiring chest tube placement, occurring in zero rebiopsies and 38 (1.4%; p = .4) controls. Molecular profiling was requested in 96 (90%) rebiopsies and successful in 92/96 (96%). CONCLUSION At our center, repeat lung biopsies for postprogression molecular profiling of EGFR-mutant lung cancers result in fewer complications than typical lung biopsies. Coaxial technique, FNA, ROSE, and multiple 20-gauge tissue cores result in excellent specimen adequacy. IMPLICATIONS FOR PRACTICE Repeat percutaneous transthoracic needle aspirations and biopsies for postprogression molecular profiling of epidermal growth factor receptor (EGFR)-mutant lung cancer are safe in everday clinical practice. Coaxial technique, fine-needle aspirates, rapid on-site pathologic evaluation, and multiple 20-gauge tissue cores result in excellent specimen adequacy. Although liquid biopsies are increasingly used, their sensitivity for analysis of resistant EGFR-mutant lung cancers remains limited. Tissue biopsies remain important in this context, especially because osimertinib is now in the frontline setting and T790M is no longer the major finding of interest on molecular profiling.
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Affiliation(s)
- Florian J Fintelmann
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Fabian M Troschel
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Martin W Kuklinski
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shaunagh McDermott
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Milena Petranovic
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Subba R Digumarthy
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amita Sharma
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amelie S Troschel
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Melissa C Price
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lida P Hariri
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Matthew D Gilman
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joanne O Shepard
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lecia V Sequist
- Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Zofia Piotrowska
- Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA
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Yield of Malignant Pleural Effusion for Detection of Oncogenic Driver Mutations in Lung Adenocarcinoma. J Bronchology Interv Pulmonol 2019; 26:96-101. [PMID: 30048416 DOI: 10.1097/lbr.0000000000000534] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pleural fluid can be used to assess targetable mutations in patients with lung adenocarcinoma. The primary objective of this study was to assess the yield of pleural fluid cytology for targetable oncogenic mutations (EGFR, KRAS, BRAF, ALK, and ROS1 gene rearrangements). We also assessed pleural fluid volume necessary for molecular testing. METHODS Retrospective review was performed of 134 consecutive patients with lung adenocarcinoma associated malignant pleural effusions. EGFR and KRAS testing was done using PCR amplification followed by DNA sequencing, or next generation sequencing in more recent cases that included BRAF assessment. Fluorescence in situ hybridization employing break-apart probes was used to test for ALK and ROS1 rearrangements. RESULTS Mutation analysis on pleural fluid cell-block was performed on 56 patients. It was adequate for complete analysis ordered including EGFR, KRAS, BRAF, ALK, and ROS1 rearrangements on 40 (71.4%) samples. For individual mutations, EGFR testing was possible in 38 of 49 (77.6%); KRAS 22 of 28 (78.6%); BRAF 10 of 13 (76.9%), ALK gene rearrangement 42 of 51 (82.4%) and ROS1 gene rearrangement in 21 of 28 (75%) pleural fluid specimens. The analysis was satisfactory in 13 of 19 (68.4%) samples with ≤100 mL versus 27 of 37 (72.9%) with >100 mL of fluid tested (P-value=0.7). CONCLUSION Genetic mutation analysis can be performed on malignant pleural effusions secondary to lung adenocarcinoma, independent of fluid volume.
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Sone M, Arai Y, Sugawara S, Kubo T, Itou C, Hasegawa T, Umakoshi N, Yamamoto N, Sunami K, Hiraoka N, Kubo T. Feasibility of genomic profiling with next-generation sequencing using specimens obtained by image-guided percutaneous needle biopsy. Ups J Med Sci 2019; 124:119-124. [PMID: 31179853 PMCID: PMC6567228 DOI: 10.1080/03009734.2019.1607635] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Aims: The demand for specimen collection for genomic profiling is rapidly increasing in the era of personalized medicine. Percutaneous needle biopsy is recognized as minimally invasive, but the feasibility of comprehensive genomic analysis using next-generation sequencing (NGS) is not yet clear. The purpose of this study was to evaluate the feasibility of genomic analysis using NGS with specimens obtained by image-guided percutaneous needle biopsy with 18-G needles. Patients and methods: Forty-eight patients who participated in a clinical study of genomic profiling with NGS with the specimen obtained by image-guided needle biopsy were included. All biopsies were performed under local anesthesia, with imaging guidance, using an 18-G cutting needle. A retrospective chart review was performed to determine the rate of successful genomic analysis, technical success rate of biopsy procedure, adverse events, rate of success in pathological diagnosis, and cause of failed genomic analysis. Results: The success rate of genomic analysis was 79.2% (38/48). The causes of failure were unprocessed for DNA extraction due to insufficient specimen volume (6/10), insufficient DNA volume (2/10), and deteriorated DNA quality (2/10). The rate of successful genomic analysis excluding NGS analysis that failed for reasons unrelated to the biopsy procedures was 95.2% (40/42). Technical success of biopsy was achieved in all patients without severe adverse events. The rate of success in the pathological diagnosis was 97.9% (47/48). Conclusions: Image-guided needle biopsy specimens using an 18-G cutting needle yielded a successful NGS genomic analysis rate with no severe adverse events and could be an adoptable method for tissue sampling for NGS.
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Affiliation(s)
- Miyuki Sone
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
- CONTACT Miyuki Sone Department of Diagnostic Radiology, National Cancer Center, 5-1-1, Tsukiji, Chuo-ku, Tokyo1040045, Japan
| | - Yasuaki Arai
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Shunsuke Sugawara
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Takatoshi Kubo
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Chihiro Itou
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Tetsuya Hasegawa
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Noriyuki Umakoshi
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Noboru Yamamoto
- Department of Experimental Therapeutics, National Cancer Center Hospital, Tokyo, Japan
| | - Kumiko Sunami
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan
| | - Nobuyoshi Hiraoka
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan
| | - Takashi Kubo
- Division of Translational Genomics, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Tokyo, Japan
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Beck KS, Kim TJ, Lee KY, Kim YK, Kang JH, Han DH. CT-guided coaxial biopsy of malignant lung lesions: are cores from 20-gauge needle adequate for histologic diagnosis and molecular analysis? J Thorac Dis 2019; 11:753-765. [PMID: 31019763 DOI: 10.21037/jtd.2019.02.48] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background To determine the number of cores adequate for histopathologic diagnosis as well as evaluate the success rate of molecular analyses in CT-guided percutaneous core needle biopsy (PCNB) for malignant pulmonary lesions using a 20-guage coaxial needle. Methods Biopsy records of 196 malignant lung lesions were reviewed. Core obtained from each needle pass was put in a separate container for individual pathological analysis. Types of molecular analysis attempted and their success rates were recorded for each patient. We categorized each patient into one of six groups according to the number of cores (n=1, n=2, n=3, n=4, n=5, n≥6) acquired, and diagnostic sensitivity for histopathologic diagnosis was calculated for each core in each group. In order to assess the increase in cumulative sensitivity up to 4th core, the data from 1st to 4th needle passes in 4-, 5-, and ≥6-core groups were pooled and cumulative diagnostic sensitivities up to 4th core were calculated. Results Of 196 cases of lung malignancies, five different types of molecular studies (EGFR mutation, ALK translocation, KRAS mutation, RET and ROS1 rearrangements) were attempted with PCNB specimens in 100 cases and successfully done in 96 cases (96.0%). In ≥4-core group (4-, 5-, and ≥6-core groups combined; n=148), cumulative sensitivity increased from 83.8% to 89.9% between 1st and 2nd cores, 89.9% to 93.2% between 2nd and 3rd cores, and 93.2% to 94.6% between 3rd and 4th cores. Conclusions The cumulative diagnostic sensitivity for the histopathologic diagnosis increases significantly between the second and fourth sampling. Multiple samples obtained with a 20-guage coaxial needle are adequate and have a high success rate for various molecular studies for lung malignancy.
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Affiliation(s)
- Kyongmin S Beck
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae-Jung Kim
- Department of Hospital Pathology, Yeouido St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyo Young Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Kyoon Kim
- Division of Pulmonology, Department of Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Hyoung Kang
- Division of Oncology, Department of Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dae Hee Han
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Kim I, Eom JS, Kim AR, Lee CH, Lee G, Jo EJ, Kim MH, Mok JH, Lee K, Kim KU, Park HK, Lee MK. Molecular analysis of small tissue samples obtained via transbronchial lung biopsy using radial probe endobronchial ultrasound. PLoS One 2019; 14:e0212672. [PMID: 30807604 PMCID: PMC6391011 DOI: 10.1371/journal.pone.0212672] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 02/07/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Radial probe endobronchial ultrasound using a guide sheath (EBUS-GS) is used to diagnose peripheral lung cancer. The aim was to identify the accuracy of molecular analysis that were performed with EBUS-GS specimens in patients with non-small cell lung cancer (NSCLC). METHOD From December 2015 to September 2017, we retrospectively studied 91 patients with peripheral NSCLC who underwent surgery after EBUS-GS. Epidermal growth factor receptor (EGFR) mutational and anaplastic lymphoma kinase (ALK) translocation status obtained from surgical specimens served as the references. RESULTS Compared to the reference data, EGFR mutational testing of EBUS-GS specimens was in 97% agreement, and the κ coefficient was 0.931 (P< 0.001). In addition, on ALK translocation testing, the results of all 91 patients were in agreement with the reference data (concordance rate of 100%, κ coefficient 1.000; P< 0.001). CONCLUSION We found that EBUS-GS could be used for molecular diagnosis, such as EGFR mutational and ALK translocation status, in patients with peripheral NSCLC.
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Affiliation(s)
- Insu Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Jung Seop Eom
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Ah Rong Kim
- Department of Pathology, Pusan National University School of Medicine, Busan, Korea
| | - Chang Hun Lee
- Department of Pathology, Pusan National University School of Medicine, Busan, Korea
| | - Geewon Lee
- Department of Radiology, Pusan National University School of Medicine, Busan, Korea
| | - Eun Jung Jo
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Mi-Hyun Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Jeong Ha Mok
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Kwangha Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Ki Uk Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Hye-Kyung Park
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Min Ki Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
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Lee KH, Lim KY, Suh YJ, Hur J, Han DH, Kang MJ, Choo JY, Kim C, Kim JI, Yoon SH, Lee W, Park CM. Nondiagnostic Percutaneous Transthoracic Needle Biopsy of Lung Lesions: A Multicenter Study of Malignancy Risk. Radiology 2018; 290:814-823. [PMID: 30561276 DOI: 10.1148/radiol.2018181482] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Purpose To evaluate the malignancy risk of lung lesions that show nondiagnostic results at transthoracic needle biopsy (PTNB) of the lung and to identify any malignancy-associated risk factors in each nondiagnostic category. Materials and Methods In this retrospective study, 9384 initial PTNBs (9239 patients [mean age, 65 years; age range, 20-99 years] consisting of 5729 men [mean age, 66 years; age range, 20-99 years] and 3510 women [mean age, 63 years; age range, 20-94 years]) were performed in eight institutions between January 2010 and December 2014. PTNB results were categorized as diagnostic (malignant or specifically benign) or nondiagnostic (nonspecific benign pathologic findings, atypical cells, or insufficient specimen), and the proportion of final malignant diagnoses per nondiagnostic category was obtained. Malignancy-associated factors were determined by using multivariable analyses. Results Nondiagnostic results were present in 27.6% (2590 of 9384) of PTNBs. Proportions of final malignant diagnoses were 21.3% (339 of 1592) for nonspecific benignities, 90.1% (503 of 558) for atypical cells, and 46.6% (205 of 440) for insufficient specimens. In the nonspecific benign category, granulomatous inflammation (odds ratio [OR], 0.04; 95% confidence interval [CI]: 0.02, 0.12; P < .001), abscess (OR, 0.04; 95% CI: 0.01, 0.28; P = .001), and organizing pneumonia (OR, 0.05; 95% CI: 0.01, 0.23; P < .001) were demonstrated to be important factors negating malignancy. Atypical cells suspicious for malignancy were more associated with malignancy (OR, 6.3; 95% CI: 1.9, 21.0; P = .003) than were atypical cells of indeterminate malignancy. All 130 lesions with atypical cells suggestive of malignancy were finally malignant. Conclusion After nondiagnostic lung biopsies, lesions categorized as atypical cell lesions have a high likelihood of malignancy, with somewhat lower likelihood for lesions with insufficient specimens and nonspecific benign categories. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Elicker in this issue.
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Affiliation(s)
- Kyung Hee Lee
- From the Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea (K.H.L.); Department of Radiology, National Cancer Center, Gyeonggi-do, South Korea (K.Y.L.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (Y.J.S., J.H.); Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (J.H.); Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (D.H.H.); Department of Radiology, Inje University Sanggyepaik Hospital, Seoul, South Korea (M.J.K.); Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, South Korea (J.Y.C., C.K.); Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, South Korea (J.I.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (S.H.Y., C.M.P.); Department of Statistics, Inha University, Incheon, South Korea (W.L.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea (C.M.P.)
| | - Kun Young Lim
- From the Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea (K.H.L.); Department of Radiology, National Cancer Center, Gyeonggi-do, South Korea (K.Y.L.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (Y.J.S., J.H.); Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (J.H.); Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (D.H.H.); Department of Radiology, Inje University Sanggyepaik Hospital, Seoul, South Korea (M.J.K.); Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, South Korea (J.Y.C., C.K.); Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, South Korea (J.I.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (S.H.Y., C.M.P.); Department of Statistics, Inha University, Incheon, South Korea (W.L.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea (C.M.P.)
| | - Young Joo Suh
- From the Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea (K.H.L.); Department of Radiology, National Cancer Center, Gyeonggi-do, South Korea (K.Y.L.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (Y.J.S., J.H.); Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (J.H.); Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (D.H.H.); Department of Radiology, Inje University Sanggyepaik Hospital, Seoul, South Korea (M.J.K.); Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, South Korea (J.Y.C., C.K.); Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, South Korea (J.I.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (S.H.Y., C.M.P.); Department of Statistics, Inha University, Incheon, South Korea (W.L.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea (C.M.P.)
| | - Jin Hur
- From the Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea (K.H.L.); Department of Radiology, National Cancer Center, Gyeonggi-do, South Korea (K.Y.L.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (Y.J.S., J.H.); Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (J.H.); Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (D.H.H.); Department of Radiology, Inje University Sanggyepaik Hospital, Seoul, South Korea (M.J.K.); Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, South Korea (J.Y.C., C.K.); Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, South Korea (J.I.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (S.H.Y., C.M.P.); Department of Statistics, Inha University, Incheon, South Korea (W.L.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea (C.M.P.)
| | - Dae Hee Han
- From the Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea (K.H.L.); Department of Radiology, National Cancer Center, Gyeonggi-do, South Korea (K.Y.L.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (Y.J.S., J.H.); Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (J.H.); Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (D.H.H.); Department of Radiology, Inje University Sanggyepaik Hospital, Seoul, South Korea (M.J.K.); Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, South Korea (J.Y.C., C.K.); Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, South Korea (J.I.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (S.H.Y., C.M.P.); Department of Statistics, Inha University, Incheon, South Korea (W.L.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea (C.M.P.)
| | - Mi-Jin Kang
- From the Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea (K.H.L.); Department of Radiology, National Cancer Center, Gyeonggi-do, South Korea (K.Y.L.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (Y.J.S., J.H.); Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (J.H.); Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (D.H.H.); Department of Radiology, Inje University Sanggyepaik Hospital, Seoul, South Korea (M.J.K.); Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, South Korea (J.Y.C., C.K.); Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, South Korea (J.I.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (S.H.Y., C.M.P.); Department of Statistics, Inha University, Incheon, South Korea (W.L.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea (C.M.P.)
| | - Ji Yung Choo
- From the Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea (K.H.L.); Department of Radiology, National Cancer Center, Gyeonggi-do, South Korea (K.Y.L.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (Y.J.S., J.H.); Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (J.H.); Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (D.H.H.); Department of Radiology, Inje University Sanggyepaik Hospital, Seoul, South Korea (M.J.K.); Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, South Korea (J.Y.C., C.K.); Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, South Korea (J.I.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (S.H.Y., C.M.P.); Department of Statistics, Inha University, Incheon, South Korea (W.L.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea (C.M.P.)
| | - Cherry Kim
- From the Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea (K.H.L.); Department of Radiology, National Cancer Center, Gyeonggi-do, South Korea (K.Y.L.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (Y.J.S., J.H.); Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (J.H.); Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (D.H.H.); Department of Radiology, Inje University Sanggyepaik Hospital, Seoul, South Korea (M.J.K.); Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, South Korea (J.Y.C., C.K.); Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, South Korea (J.I.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (S.H.Y., C.M.P.); Department of Statistics, Inha University, Incheon, South Korea (W.L.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea (C.M.P.)
| | - Jung Im Kim
- From the Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea (K.H.L.); Department of Radiology, National Cancer Center, Gyeonggi-do, South Korea (K.Y.L.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (Y.J.S., J.H.); Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (J.H.); Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (D.H.H.); Department of Radiology, Inje University Sanggyepaik Hospital, Seoul, South Korea (M.J.K.); Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, South Korea (J.Y.C., C.K.); Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, South Korea (J.I.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (S.H.Y., C.M.P.); Department of Statistics, Inha University, Incheon, South Korea (W.L.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea (C.M.P.)
| | - Soon Ho Yoon
- From the Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea (K.H.L.); Department of Radiology, National Cancer Center, Gyeonggi-do, South Korea (K.Y.L.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (Y.J.S., J.H.); Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (J.H.); Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (D.H.H.); Department of Radiology, Inje University Sanggyepaik Hospital, Seoul, South Korea (M.J.K.); Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, South Korea (J.Y.C., C.K.); Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, South Korea (J.I.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (S.H.Y., C.M.P.); Department of Statistics, Inha University, Incheon, South Korea (W.L.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea (C.M.P.)
| | - Woojoo Lee
- From the Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea (K.H.L.); Department of Radiology, National Cancer Center, Gyeonggi-do, South Korea (K.Y.L.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (Y.J.S., J.H.); Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (J.H.); Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (D.H.H.); Department of Radiology, Inje University Sanggyepaik Hospital, Seoul, South Korea (M.J.K.); Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, South Korea (J.Y.C., C.K.); Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, South Korea (J.I.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (S.H.Y., C.M.P.); Department of Statistics, Inha University, Incheon, South Korea (W.L.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea (C.M.P.)
| | - Chang Min Park
- From the Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea (K.H.L.); Department of Radiology, National Cancer Center, Gyeonggi-do, South Korea (K.Y.L.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (Y.J.S., J.H.); Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (J.H.); Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (D.H.H.); Department of Radiology, Inje University Sanggyepaik Hospital, Seoul, South Korea (M.J.K.); Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, South Korea (J.Y.C., C.K.); Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, South Korea (J.I.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (S.H.Y., C.M.P.); Department of Statistics, Inha University, Incheon, South Korea (W.L.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea (C.M.P.)
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Ferry-Galow KV, Datta V, Makhlouf HR, Wright J, Wood BJ, Levy E, Pisano ED, Tam AL, Lee SI, Mahmood U, Rubinstein LV, Doroshow JH, Chen AP. What Can Be Done to Improve Research Biopsy Quality in Oncology Clinical Trials? J Oncol Pract 2018; 14:JOP1800092. [PMID: 30285529 PMCID: PMC6237512 DOI: 10.1200/jop.18.00092] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE: Research biopsy specimens collected in clinical trials often present requirements beyond those of tumor biopsy specimens collected for diagnostic purposes. Research biopsies underpin hypothesis-driven drug development, pharmacodynamic assessment of molecularly targeted anticancer agents, and, increasingly, genomic assessment for precision medicine; insufficient biopsy specimen quality or quantity therefore compromises the scientific value of a study and the resources devoted to it, as well as each patient's contribution to and potential benefit from a clinical trial. METHODS: To improve research biopsy specimen quality, we consulted with other translational oncology teams and reviewed current best practices. RESULTS: Among the recommendations were improving communication between oncologists and interventional radiologists, providing feedback on specimen sufficiency, increasing academic recognition and financial support for the time investment required by radiologists to collect and preserve research biopsy specimens, and improving real-time assessment of tissue quality. CONCLUSION: Implementing these recommendations at the National Cancer Institute's Developmental Therapeutics Clinic has demonstrably improved the quality of biopsy specimens collected; more widespread dissemination of these recommendations beyond large clinical cancer centers is possible and will be of value to the community in improving clinical research and, ultimately, patient care.
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Affiliation(s)
- Katherine V. Ferry-Galow
- Frederick National Laboratory for Cancer Research, Frederick; National Cancer Institute, Bethesda MD; Beth Israel Deaconess Medical Center; Harvard Medical School; Massachusetts General Hospital, Boston, MA; American College of Radiology, Reston, VA; and University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vivekananda Datta
- Frederick National Laboratory for Cancer Research, Frederick; National Cancer Institute, Bethesda MD; Beth Israel Deaconess Medical Center; Harvard Medical School; Massachusetts General Hospital, Boston, MA; American College of Radiology, Reston, VA; and University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hala R. Makhlouf
- Frederick National Laboratory for Cancer Research, Frederick; National Cancer Institute, Bethesda MD; Beth Israel Deaconess Medical Center; Harvard Medical School; Massachusetts General Hospital, Boston, MA; American College of Radiology, Reston, VA; and University of Texas MD Anderson Cancer Center, Houston, TX
| | - John Wright
- Frederick National Laboratory for Cancer Research, Frederick; National Cancer Institute, Bethesda MD; Beth Israel Deaconess Medical Center; Harvard Medical School; Massachusetts General Hospital, Boston, MA; American College of Radiology, Reston, VA; and University of Texas MD Anderson Cancer Center, Houston, TX
| | - Bradford J. Wood
- Frederick National Laboratory for Cancer Research, Frederick; National Cancer Institute, Bethesda MD; Beth Israel Deaconess Medical Center; Harvard Medical School; Massachusetts General Hospital, Boston, MA; American College of Radiology, Reston, VA; and University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elliot Levy
- Frederick National Laboratory for Cancer Research, Frederick; National Cancer Institute, Bethesda MD; Beth Israel Deaconess Medical Center; Harvard Medical School; Massachusetts General Hospital, Boston, MA; American College of Radiology, Reston, VA; and University of Texas MD Anderson Cancer Center, Houston, TX
| | - Etta D. Pisano
- Frederick National Laboratory for Cancer Research, Frederick; National Cancer Institute, Bethesda MD; Beth Israel Deaconess Medical Center; Harvard Medical School; Massachusetts General Hospital, Boston, MA; American College of Radiology, Reston, VA; and University of Texas MD Anderson Cancer Center, Houston, TX
| | - Alda L. Tam
- Frederick National Laboratory for Cancer Research, Frederick; National Cancer Institute, Bethesda MD; Beth Israel Deaconess Medical Center; Harvard Medical School; Massachusetts General Hospital, Boston, MA; American College of Radiology, Reston, VA; and University of Texas MD Anderson Cancer Center, Houston, TX
| | - Susanna I. Lee
- Frederick National Laboratory for Cancer Research, Frederick; National Cancer Institute, Bethesda MD; Beth Israel Deaconess Medical Center; Harvard Medical School; Massachusetts General Hospital, Boston, MA; American College of Radiology, Reston, VA; and University of Texas MD Anderson Cancer Center, Houston, TX
| | - Umar Mahmood
- Frederick National Laboratory for Cancer Research, Frederick; National Cancer Institute, Bethesda MD; Beth Israel Deaconess Medical Center; Harvard Medical School; Massachusetts General Hospital, Boston, MA; American College of Radiology, Reston, VA; and University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lawrence V. Rubinstein
- Frederick National Laboratory for Cancer Research, Frederick; National Cancer Institute, Bethesda MD; Beth Israel Deaconess Medical Center; Harvard Medical School; Massachusetts General Hospital, Boston, MA; American College of Radiology, Reston, VA; and University of Texas MD Anderson Cancer Center, Houston, TX
| | - James H. Doroshow
- Frederick National Laboratory for Cancer Research, Frederick; National Cancer Institute, Bethesda MD; Beth Israel Deaconess Medical Center; Harvard Medical School; Massachusetts General Hospital, Boston, MA; American College of Radiology, Reston, VA; and University of Texas MD Anderson Cancer Center, Houston, TX
| | - Alice P. Chen
- Frederick National Laboratory for Cancer Research, Frederick; National Cancer Institute, Bethesda MD; Beth Israel Deaconess Medical Center; Harvard Medical School; Massachusetts General Hospital, Boston, MA; American College of Radiology, Reston, VA; and University of Texas MD Anderson Cancer Center, Houston, TX
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Le-Rademacher J, Dahlberg S, Lee JJ, Adjei AA, Mandrekar SJ. Biomarker Clinical Trials in Lung Cancer: Design, Logistics, Challenges, and Practical Considerations. J Thorac Oncol 2018; 13:1625-1637. [PMID: 30194034 DOI: 10.1016/j.jtho.2018.08.2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/10/2018] [Accepted: 08/15/2018] [Indexed: 10/28/2022]
Abstract
Treatment for lung cancer has evolved in the past 3 decades starting with platinum-based chemotherapy as the standard of care, regardless of histology, in the early 1990s to the current age of biomarker-driven therapy. Consequently, clinical trials in lung cancer have evolved in response to this new shift of paradigm, leading to novel approaches that simultaneously shorten the development process and allow evaluation of multiple patient cohorts. Herein, we provide an overview of the landscape of lung cancer clinical trials in the era of targeted therapies, precision medicine, and biomarkers. Specific trials are given as examples to illustrate the design paradigms. The paper is organized by drug development phases starting with early-phase biomarker discovery to proof-of-concept trials to definitive trials. We also present some thoughts on future directions.
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Affiliation(s)
| | | | - J Jack Lee
- MD Anderson Cancer Institute, Houston, Texas
| | - Alex A Adjei
- Department of Oncology, Mayo Clinic, Rochester, Minnesota
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Kumar R, Dubashi B, Kayal S, Lazzar SC, Barathi D, Kumar V. Study of gefitinib maintenance in unselected patients with metastatic primary lung adenocarcinoma: A descriptive study. Indian J Cancer 2018; 54:188-192. [PMID: 29199688 DOI: 10.4103/ijc.ijc_46_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Maintenance treatment of patients with advanced nonsmall cell lung cancer (NSCLC) without disease progression after first-line chemotherapy is a subject of ongoing research. The aim of this study was to investigate the efficacy, safety, and tolerability of the epidermal growth factor receptor (EGFR)-tyrosine-kinase inhibitor, i.e., gefitinib in the maintenance setting irrespective of EGFR status. METHODS Patients aged 18 years or older of Indian origin, who had a life expectancy of >12 weeks with histologically or cytologically confirmed Stage IV NSCLC, the WHO performance status of 0-2, and who had completed four to six cycles of first-line platinum-based doublet chemotherapy without disease progression or unacceptable toxic effects were included in the study. The primary endpoint of the study was progression-free survival in the intention-to-treat population. RESULTS Twenty-five patients with a median age of 55 years (40-68) were included in the study. The median progression-free survival (PFS) for the entire group was 8 months (95% confidence interval [CI] =1.45-14.54) had not reached for EGFR-positive patient, but in the EGFR negative cohort, the PFS was 4.98 months (hazard ratio = 0.092, 95% CI = 3.4-6.5, P = 0.01). The median overall survival (OS) of the study group was 15 months (95% CI = 3.7-26.4), all patients with EGFR positive were alive (100% survival). The median OS for EGFR negative group was about 6.3 months. The major toxicity observed was rash/acne in 15 patients, pruritus in 7 patients, and one patient had Grade 4 pneumonitis. CONCLUSION Gefitinib maintenance is safe, well-tolerated therapy, produces significant PFS and OS benefit in EGFR mutation-positive patient. It is definitely not a choice for EGFR negative group. In EGFR unknown group, the role of maintenance still needs to be explored.
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Affiliation(s)
- R Kumar
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - B Dubashi
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - S Kayal
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - S C Lazzar
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - D Barathi
- Department of Radio-diagnosis and Imaging, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - V Kumar
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Lesser TG, Petersen I, Pölzing F, Wolfram F. One-Lung Flooding Enables Ultrasound-Guided Transthoracic Needle Biopsy of Pulmonary Nodules with High Sensitivity. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:1556-1562. [PMID: 29627084 DOI: 10.1016/j.ultrasmedbio.2018.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 02/27/2018] [Accepted: 03/01/2018] [Indexed: 06/08/2023]
Abstract
Ultrasound-guided transthoracic needle biopsy (USgTTNB) can only be used for peripheral tumours that contact the pleura. Sonographic accessibility of the entire lung can be achieved using one-lung flooding. In this study, feasibility, sensitivity and complication rate of USgTTNB of lung nodules after one-lung flooding in an ex vivo and in vivo lung tumour model were assessed. USgTTNB was performed ex vivo after one-lung flooding in 10 resected human lung lobes containing carcinoma or metastasis. USgTTNB after one-lung flooding and simulation of a lung nodule was conducted in vivo in 5 animals. Transthoracic sonography and chest X-ray were obtained 30 min after reventilation. The lungs were examined macroscopically and histopathologically. The pathologic diagnosis was confirmed in 85.7% and 100% of tumours after first and second puncture attempts, respectively. The successful puncture rate in vivo was 90%. Neither pneumothorax nor bleeding was observed. One-lung flooding enables USgTTNB of lung nodules with a high sensitivity and minimal risk of complications in a pre-clinical model.
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Affiliation(s)
- Thomas Günter Lesser
- Department of Thoracic and Vascular Surgery, SRH Wald-Klinikum Gera, Teaching Hospital of Friedrich-Schiller University of Jena, Gera, Germany.
| | - Iver Petersen
- Institute of Pathology, SRH Wald-Klinikum Gera, Teaching Hospital of Friedrich-Schiller University of Jena, Gera, Germany
| | - Frank Pölzing
- Community for the promotion of innovative medicine, Beichlingen, Germany
| | - Frank Wolfram
- Department of Thoracic and Vascular Surgery, SRH Wald-Klinikum Gera, Teaching Hospital of Friedrich-Schiller University of Jena, Gera, Germany
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Abraham E, Post K, Spring L, Malvarosa G, Tripp E, Peppercorn J, Bardia A, Habin K. Research Biopsies: An Integrative Review of the Experiences of Patients With Cancer. Clin J Oncol Nurs 2018; 22:E71-E77. [DOI: 10.1188/18.cjon.e71-e77] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Shen D, Yu X, Wu Y, Chen Y, Li G, Cheng F, Xia L. Emerging roles of bexarotene in the prevention, treatment and anti-drug resistance of cancers. Expert Rev Anticancer Ther 2018. [PMID: 29521139 DOI: 10.1080/14737140.2018.1449648] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Danyang Shen
- Department of Urology and Chawnshang Chang Liver Cancer Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaoming Yu
- Department of Urology and Chawnshang Chang Liver Cancer Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yan Wu
- Department of Pharmacy, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yuanlei Chen
- Department of Urology and Chawnshang Chang Liver Cancer Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Gonghui Li
- Department of Urology and Chawnshang Chang Liver Cancer Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Feng Cheng
- College of Biotechnology and Bioengineering, Zhejiang University of Technology, Hangzhou, China
| | - Liqun Xia
- Department of Urology and Chawnshang Chang Liver Cancer Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Abstract
Image-guided percutaneous transthoracic needle biopsy (PTNB) is a well-established and minimally invasive technique for evaluating pulmonary nodules. Implementation of a national lung screening program and increased use of chest computed tomography have contributed to the frequent identification of indeterminate pulmonary nodules that may require tissue sampling. The advent of biomarker-driven lung cancer therapy has led to increased use of repeat PTNB after diagnosis. Percutaneous insertion of markers for preoperative localization of small nodules can aid in minimally invasive surgery and radiation treatment planning. This article discusses PTNB, patient selection, and biopsy technique, including minimizing and managing complications.
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Affiliation(s)
- Amita Sharma
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Founders 202, Boston, MA 02114, USA.
| | - Jo-Anne O Shepard
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Founders 202, Boston, MA 02114, USA
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Characteristics of percutaneous core biopsies adequate for next generation genomic sequencing. PLoS One 2017; 12:e0189651. [PMID: 29281680 PMCID: PMC5744968 DOI: 10.1371/journal.pone.0189651] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 11/28/2017] [Indexed: 12/18/2022] Open
Abstract
Purpose Determine the characteristics of percutaneous core biopsies that are adequate for a next generation sequencing (NGS) genomic panel. Materials and methods All patients undergoing percutaneous core biopsies in interventional radiology (IR) with samples evaluated for a 46-gene NGS panel during 1-year were included in this retrospective study. Patient and procedure variables were collected. An imaging-based likelihood of adequacy score incorporating targeting and sampling factors was assigned to each biopsied lesion. Univariate and multivariate logistic regression was performed. Results 153 patients were included (58.2% female, average age 59.5 years). The most common malignancy was lung cancer (40.5%), most common biopsied site was lung (36%), and average size of biopsied lesions was 3.8 cm (+/- 2.7). Adequacy for NGS was 69.9%. Univariate analysis showed higher likelihood of adequacy score (p = 0.004), primary malignancy type (p = 0.03), and absence of prior systemic therapy (p = 0.018) were associated with adequacy for NGS. Multivariate analysis showed higher adequacy for lesions with likelihood of adequacy scored 3 (high) versus lesions scored 1 (low) (OR, 7.82; p = 0.002). Melanoma lesions had higher adequacy for NGS versus breast cancer lesions (OR 9.5; p = 0.01). Absence of prior systemic therapy (OR, 6.1; p = 0.02) and systemic therapy </ = 3 months (OR 3.24; p = 0.01) compared to systemic therapy >3 months before biopsy yielded greater adequacy for NGS. Lesions <3 cm had greater adequacy for NGS than larger lesions (OR 2.72, p = 0.02). Conclusion As targeted therapy becomes standard for more cancers, percutaneous biopsy specimens adequate for NGS genomic testing will be needed. An imaging-based likelihood of adequacy score assigned by IR physicians and other pre-procedure variables can help predict the likelihood of biopsy adequacy for NGS.
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Determining the Optimal Number of Core Needle Biopsy Passes for Molecular Diagnostics. Cardiovasc Intervent Radiol 2017; 41:489-495. [PMID: 29279975 DOI: 10.1007/s00270-017-1861-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 12/14/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE The number of core biopsy passes required for adequate next-generation sequencing is impacted by needle cut, needle gauge, and the type of tissue involved. This study evaluates diagnostic adequacy of core needle lung biopsies based on number of passes and provides guidelines for other tissues based on simulated biopsies in ex vivo porcine organ tissues. METHODS The rate of diagnostic adequacy for pathology and molecular testing from lung biopsy procedures was measured for eight operators pre-implementation (September 2012-October 2013) and post-implementation (December 2013-April 2014) of a standard protocol using 20-gauge side-cut needles for ten core biopsy passes at a single academic hospital. Biopsy pass volume was then estimated in ex vivo porcine muscle, liver, and kidney using side-cut devices at 16, 18, and 20 gauge and end-cut devices at 16 and 18 gauge to estimate minimum number of passes required for adequate molecular testing. RESULTS Molecular diagnostic adequacy increased from 69% (pre-implementation period) to 92% (post-implementation period) (p < 0.001) for lung biopsies. In porcine models, both 16-gauge end-cut and side-cut devices require one pass to reach the validated volume threshold to ensure 99% adequacy for molecular characterization, while 18- and 20-gauge devices require 2-5 passes depending on needle cut and tissue type. CONCLUSION Use of 20-gauge side-cut core biopsy needles requires a significant number of passes to ensure diagnostic adequacy for molecular testing across all tissue types. To ensure diagnostic adequacy for molecular testing, 16- and 18-gauge needles require markedly fewer passes.
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Hasegawa T, Kondo C, Sato Y, Inaba Y, Yamaura H, Kato M, Murata S, Onoda Y, Kuroda H, Sakao Y, Yatabe Y. Pathologic Diagnosis and Genetic Analysis of a Lung Tumor Needle Biopsy Specimen Obtained Immediately After Radiofrequency Ablation. Cardiovasc Intervent Radiol 2017; 41:594-602. [PMID: 29164309 DOI: 10.1007/s00270-017-1845-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/13/2017] [Indexed: 12/28/2022]
Abstract
PURPOSE To evaluate the possibility of pathologic diagnosis and genetic analysis of percutaneous core-needle biopsy (CNB) lung tumor specimens obtained immediately after radiofrequency ablation (RFA). MATERIALS AND METHODS Patients who underwent CNB of lung tumors immediately after RFA from May 2013 to May 2016 were analyzed. There were 19 patients (8 men and 11 women; median age, 69 years; range, 52-88 years) and 19 lung tumors measuring 0.5-2.6 cm (median, 1.6 cm). Thirteen tumors were solid, and 6 were predominantly ground-glass opacity (GGO) on computed tomography. All specimens were pathologically examined using hematoxylin and eosin (H&E) staining and additional immunostaining, as necessary. The specimens were analyzed for EGFR and KRAS genetic mutations. The safety and technical success rate of the procedure and the possibility of pathologic diagnosis and genetic mutation analysis were evaluated. RESULTS Major and minor complication rates were 11% (2/19) and 53% (10/19), respectively. Tumor cells were successfully obtained in 16 cases (84%, 16/19), and technical success rate was significantly lower for GGO-dominant tumors (50%, 3/6) compared with solid lesions (100%, 13/13, p = 0.02). Pathologic diagnosis was possible in 79% (15/19) of cases based on H&E staining alone (n = 12) and with additional immunostaining (n = 3). Although atypical cells were obtained, pathologic diagnosis could not be achieved in 1 case (5%, 1/19). Both EGFR and KRAS mutations could be analyzed in 74% (14/19) of the specimens. CONCLUSION Pathologic diagnosis and genetic analysis could be performed even for lung tumor specimens obtained immediately after RFA.
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Affiliation(s)
- Takaaki Hasegawa
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, 1-1 Chikusa-ku Kanokoden, Nagoya, Aichi, 464-8681, Japan.
| | - Chiaki Kondo
- Department of Pathology and Molecular Diagnosis, Aichi Cancer Center Hospital, 1-1 Chikusa-ku Kanokoden, Nagoya, Aichi, 464-8681, Japan
| | - Yozo Sato
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, 1-1 Chikusa-ku Kanokoden, Nagoya, Aichi, 464-8681, Japan
| | - Yoshitaka Inaba
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, 1-1 Chikusa-ku Kanokoden, Nagoya, Aichi, 464-8681, Japan
| | - Hidekazu Yamaura
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, 1-1 Chikusa-ku Kanokoden, Nagoya, Aichi, 464-8681, Japan
| | - Mina Kato
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, 1-1 Chikusa-ku Kanokoden, Nagoya, Aichi, 464-8681, Japan
| | - Shinichi Murata
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, 1-1 Chikusa-ku Kanokoden, Nagoya, Aichi, 464-8681, Japan
| | - Yui Onoda
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, 1-1 Chikusa-ku Kanokoden, Nagoya, Aichi, 464-8681, Japan
| | - Hiroaki Kuroda
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, 1-1 Chikusa-ku Kanokoden, Nagoya, Aichi, 464-8681, Japan
| | - Yukinori Sakao
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, 1-1 Chikusa-ku Kanokoden, Nagoya, Aichi, 464-8681, Japan
| | - Yasushi Yatabe
- Department of Pathology and Molecular Diagnosis, Aichi Cancer Center Hospital, 1-1 Chikusa-ku Kanokoden, Nagoya, Aichi, 464-8681, Japan
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Tokaca N, Barth S, O'Brien M, Bhosle J, Fotiadis N, Wotherspoon A, Thompson L, Popat S. Molecular Adequacy of Image-Guided Rebiopsies for Molecular Retesting in Advanced Non-Small Cell Lung Cancer: A Single-Center Experience. J Thorac Oncol 2017; 13:63-72. [PMID: 28989040 DOI: 10.1016/j.jtho.2017.09.1958] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 09/13/2017] [Accepted: 09/22/2017] [Indexed: 01/08/2023]
Abstract
INTRODUCTION In the era of biomarker-driven systemic therapy for advanced NSCLC, the role of routine repeated biopsies for decision making outside EGFR-mutant disease remains unproven. We report our center's experience of safety and adequacy for molecular retesting of tumor material obtained from image-guided lung rebiopsies in NSCLC. METHODS We performed a retrospective case note analysis of patients undergoing image-guided lung rebiopsies at a single cancer center between 2011 and 2014. The primary objective was to determine the pathological success rate. Secondary and exploratory objectives were to determine technical success rate, histological concordance, molecular adequacy, genotypes identified, and complication rate. RESULTS In all, 103 patients underwent transthoracic image-guided procedures. A total of 66 rebiopsies in NSCLC were identified and analyzed. The pathological success rate was 87.1%. A high histological discordance rate was observed (12 of 52 evaluable cases [23.1%]). Pretest molecular adequacy as determined by the lung pathologist was 78.8% (52 of 66). Of 52 adequate samples 51 were sent for molecular analysis, with a total of 209 genes analyzed (including EGFR, ALK receptor tyrosine kinase gene [ALK], KRAS, BRAF, dicoidin domain receptor tyrosine kinase 2 gene [DDR2], NRAS, ROS1, and rearranged during transfection proto-oncogene gene [RET]). The rate of postgenotyping molecular adequacy was 87.1% (182 of 209). Overall, 20 new potentially actionable mutations were identified, with 13 of 66 patients (19.7%) starting to receive new targeted treatment as a result. Overall, rebiopsies informed clinical decision making in 63.6% of cases. The rates of complications were 15% for pneumothorax, 3% for pneumothorax requiring chest drain, and 8% for hemoptysis. CONCLUSIONS We have validated the pathological and molecular adequacy rates of rebiopsies and demonstrated clinical utility in routine decision making.
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Affiliation(s)
- Nadza Tokaca
- Lung Unit, Royal Marsden Hospital, London, United Kingdom
| | - Sarah Barth
- Lung Unit, Royal Marsden Hospital, London, United Kingdom
| | - Mary O'Brien
- Lung Unit, Royal Marsden Hospital, London, United Kingdom
| | | | - Nicos Fotiadis
- Department of Interventional Radiology, Royal Marsden Hospital, London, United Kingdom
| | - Andrew Wotherspoon
- Department of Histopathology, Royal Marsden Hospital, London, United Kingdom
| | - Lisa Thompson
- The Centre of Molecular Pathology, Institute of Cancer Research, Sutton, United Kingdom
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Bubendorf L, Lantuejoul S, de Langen AJ, Thunnissen E. Nonsmall cell lung carcinoma: diagnostic difficulties in small biopsies and cytological specimens. Eur Respir Rev 2017; 26:26/144/170007. [DOI: 10.1183/16000617.0007-2017] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/15/2017] [Indexed: 12/31/2022] Open
Abstract
The pathological and molecular classification of lung cancer has become substantially more complex over the past decade. For diagnostic purposes on small samples, additional stains are frequently required to distinguish between squamous cell carcinoma and adenocarcinoma. Subsequently, for advanced nonsquamous cell nonsmall cell lung carcinoma (NSCLC) patients, predictive analyses on epidermal growth factor receptor, anaplastic lymphoma kinase and ROS1 are required. In NSCLCs negative for these biomarkers, programmed death ligand-1 immunohistochemistry is performed. Small samples (biopsy and cytology) require “tissue” management, which is best achieved by the interaction of all physicians involved.
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Veltri A, Bargellini I, Giorgi L, Almeida PAMS, Akhan O. CIRSE Guidelines on Percutaneous Needle Biopsy (PNB). Cardiovasc Intervent Radiol 2017; 40:1501-1513. [PMID: 28523447 DOI: 10.1007/s00270-017-1658-5] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 04/20/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Andrea Veltri
- Radiology Unit, Oncology Department, San Luigi Gonzaga Hospital, University of Torino, Regione Gonzole, 10, 10043, Orbassano, Turin, Italy.
| | - Irene Bargellini
- Department of Interventional Radiology, Pisa University Hospital, Via Paradisa 2, 56100, Pisa, Italy
| | - Luigi Giorgi
- Department of Interventional Radiology, Pisa University Hospital, Via Paradisa 2, 56100, Pisa, Italy
| | | | - Okan Akhan
- Department of Radiology, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
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Lim C, Sekhon HS, Cutz JC, Hwang DM, Kamel-Reid S, Carter RF, Santos GDC, Waddell T, Binnie M, Patel M, Paul N, Chung T, Brade A, El-Maraghi R, Sit C, Tsao MS, Leighl NB. Improving molecular testing and personalized medicine in non-small-cell lung cancer in Ontario. ACTA ACUST UNITED AC 2017; 24:103-110. [PMID: 28490924 DOI: 10.3747/co.24.3495] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although molecular testing has become standard in managing advanced nonsquamous non-small-cell lung cancer (nsclc), most patients undergo minimally invasive procedures, and the diagnostic tumour specimens available for testing are usually limited. A knowledge translation initiative to educate diagnostic specialists about sampling techniques and laboratory processes was undertaken to improve the uptake and application of molecular testing in advanced lung cancer. METHODS A multidisciplinary panel of physician experts including pathologists, respirologists, interventional thoracic radiologists, thoracic surgeons, medical oncologists, and radiation oncologists developed a specialty-specific education program, adapting international clinical guidelines to the local Ontario context. Expert recommendations from the program are reported here. RESULTS Panel experts agreed that specialists procuring samples for lung cancer diagnosis should choose biopsy techniques that maximize tumour cellularity, and that conservation strategies to maximize tissue for molecular testing should be used in tissue processing. The timeliness of molecular reporting can be improved by pathologist-initiated reflex testing upon confirmation of nonsquamous nsclc and by prompt transportation of specimens to designated molecular diagnostic centres. To coordinate timely molecular testing and optimal treatment, collaboration and communication between all clinicians involved in diagnosing patients with advanced lung cancer are mandatory. CONCLUSIONS Knowledge transfer to diagnostic lung cancer specialists could potentially improve molecular testing and treatment for advanced lung cancer patients.
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Affiliation(s)
- C Lim
- Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto
| | - H S Sekhon
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa
| | - J C Cutz
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton
| | - D M Hwang
- Laboratory Medicine Program, University Health Network, University of Toronto, Toronto
| | - S Kamel-Reid
- Laboratory Medicine Program, University Health Network, University of Toronto, Toronto.,Molecular Diagnostics Laboratory, University Health Network, Toronto
| | - R F Carter
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton.,LifeLabs Genetics, Toronto
| | - G da Cunha Santos
- Laboratory Medicine Program, University Health Network, University of Toronto, Toronto
| | - T Waddell
- Division of Thoracic Surgery, University of Toronto, Toronto
| | - M Binnie
- Division of Respirology, University of Toronto, Toronto
| | - M Patel
- Division of Respirology, Trillium Health Partners, Mississauga
| | - N Paul
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, Toronto
| | - T Chung
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, Toronto
| | - A Brade
- Department of Radiation Oncology, University of Toronto, Toronto
| | - R El-Maraghi
- Simcoe Muskoka Regional Cancer Centre, Barrie; and
| | - C Sit
- Lung Cancer Canada, Toronto, ON
| | - M S Tsao
- Laboratory Medicine Program, University Health Network, University of Toronto, Toronto
| | - N B Leighl
- Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto
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Veltri A, Busso M, Sardo D, Angelino V, Priola AM, Novello S, Barba M, Gatti G, Righi L. Helical-Tip Needle for Transthoracic Percutaneous Image-Guided Biopsy of Lung Tumors: Results of a Pilot Prospective Comparative Study with a Standard Tru-Cut Needle. Cardiovasc Intervent Radiol 2017; 40:930-936. [PMID: 28127631 DOI: 10.1007/s00270-017-1585-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 01/17/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE To prospectively evaluate feasibility and diagnostic performance of the 14-gauge helical-tip (Spirotome™, Cook® Medical, Bloomington, USA) needle in transthoracic needle biopsy (TTNB) of lung lesions, compared to a conventional 18-gauge Tru-Cut needle. MATERIALS AND METHODS Study was institutional review board approved, with informed consent obtained. Data from synchronous Spirotome and Tru-Cut image-guided TTNB of 20 consecutive patients with malignant peripheral lung tumors larger than 3 cm were enrolled for pathologic characterization and mutational analysis. Samples obtained with Spirotome and Tru-Cut needle were compared for fragmentation, length, weight, morphologic and immunohistochemistry typifying, tumor cellularity (TC) and DNA concentration. RESULTS The technical success rate for TTNB with Spirotome was 100%, and no major complications occurred. Less fragmentation (mean 2 vs. 3 fragments, P = .418), greater weight (mean 13 vs. 8.5 mg, P = .027) and lower length (mean 10.2 vs. 12.6 mm, P = .174) were observed with Spirotome compared to Tru-Cut needle. Accuracy of Spirotome and Tru-Cut needle in defining cancer histotype was similar (90%). Absolute and relative TC (mean 42 vs. 38, 124 vs. 108/10HPF), and DNA concentration (mean 49.6 vs. 39.0 ng/μl) were higher with Spirotome compared to Tru-Cut needle, with no statistical significance (P = .787 and P = .140, respectively). CONCLUSIONS Percutaneous 14-gauge Spirotome TTNB of selected lesions is feasible and accurate. It provides adequate samples for diagnosis, comparable to 18-gauge Tru-Cut needle, with a higher amount of tumor tissue (weight, TC, DNA concentration) even in shorter samples.
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Affiliation(s)
- Andrea Veltri
- Department of Radiology, San Luigi Gonzaga Hospital, University of Torino, Regione Gonzole 10, 10043, Orbassano, Turin, Italy.
| | - Marco Busso
- Department of Radiology, San Luigi Gonzaga Hospital, University of Torino, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Diego Sardo
- Department of Radiology, San Luigi Gonzaga Hospital, University of Torino, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Valeria Angelino
- Department of Radiology, San Luigi Gonzaga Hospital, University of Torino, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Adriano M Priola
- Department of Radiology, San Luigi Gonzaga Hospital, University of Torino, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Silvia Novello
- Department of Oncology, San Luigi Gonzaga Hospital, University of Torino, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Matteo Barba
- Department of Radiology, San Luigi Gonzaga Hospital, University of Torino, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Gaia Gatti
- Department of Pathology, San Luigi Gonzaga Hospital, University of Torino, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Luisella Righi
- Department of Pathology, San Luigi Gonzaga Hospital, University of Torino, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
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