Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
Clin Lung Cancer. 2013 Nov;14(6):719-25. doi: 10.1016/j.cllc.2013.06.002. Epub 2013 Jul 25.
Recent advances in the treatment of NSCLC highlight the importance of distinguishing NSCLC subtypes and genotypes. We aimed to determine whether histological specimens obtained from computed tomography (CT)-guided biopsy are suitable for specific subtyping and epidermal growth factor receptor (EGFR) analyses of NSCLC.
The clinicohistological data of 332 consecutive patients undergoing 352 CT-guided biopsies for lung lesions between January 2007 and December 2011 were retrospectively analyzed. Additionally, NSCLC specimens were examined for the suitability of EGFR mutational testing.
Of 209 specimens diagnosed as NSCLC, 197 (94.3%) were specifically subtyped into adenocarcinoma (n = 164; 78.5%), squamous cell carcinoma (n = 27; 12.9%) and other subtypes (n = 6; 2.9%). The rate of NSCLC not otherwise specified (NOS) was 5.7%, and the diagnosis of NSCLC-NOS was significantly associated with the poor differentiation of cancer (adjusted odds ratio, 6.17; 95% confidence interval, 1.62-23.55; P = .008). Of 134 histological tumor specimens submitted for EGFR molecular testing, 132 (98.5%) were suitable for analyses, and 130 of them (98.5%) showed conclusive results, revealing 59.8% (n = 79) with EGFR exon mutation(s). The sensitivity, specificity, and positive and negative predictive values of CT-guided biopsy in patients with malignancy were 92.2%, 100%, 100%, and 74.1%, respectively. Six percent (n = 21) of total lung biopsies led to pneumothorax requiring chest drainage, and no procedure-related fatality was observed.
Small tumor specimens obtained with CT-guided needle lung biopsy are suitable for specific subtyping and EGFR analyses of NSCLC, thus providing critical information for personalized therapy.
最近非小细胞肺癌 (NSCLC) 治疗的进展强调了区分 NSCLC 亚型和基因型的重要性。我们旨在确定 CT 引导下活检获得的组织学标本是否适合 NSCLC 的特定亚型和表皮生长因子受体 (EGFR) 分析。
回顾性分析了 2007 年 1 月至 2011 年 12 月期间连续 332 例因肺部病变接受 352 次 CT 引导下活检的患者的临床病理数据。此外，还检查了 NSCLC 标本是否适合 EGFR 突变检测。
209 例诊断为 NSCLC 的标本中，197 例（94.3%）特异性地分为腺癌（n = 164；78.5%）、鳞状细胞癌（n = 27；12.9%）和其他亚型（n = 6；2.9%）。非特指型非小细胞肺癌（NSCLC-NOS）的发生率为 5.7%，且癌症分化不良与 NSCLC-NOS 的诊断显著相关（调整优势比，6.17；95%置信区间，1.62-23.55；P =.008）。134 例提交 EGFR 分子检测的组织学肿瘤标本中，132 例（98.5%）适合分析，其中 130 例（98.5%）得到明确结果，显示 59.8%（n = 79）存在 EGFR 外显子突变。CT 引导下活检对恶性肿瘤患者的敏感性、特异性、阳性和阴性预测值分别为 92.2%、100%、100%和 74.1%。6%（n = 21）的总肺活检导致需要胸腔引流的气胸，且未观察到与操作相关的死亡。
CT 引导下针吸肺活检获得的小肿瘤标本适合 NSCLC 的特定亚型和 EGFR 分析，从而为个体化治疗提供关键信息。
