优化支气管内超声进行分子分析。需要多少次通过？

Optimizing endobronchial ultrasound for molecular analysis. How many passes are needed?

机构信息

1 Section of Interventional Pulmonology, Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, Maryland.

出版信息

Ann Am Thorac Soc. 2013 Dec;10(6):636-43. doi: 10.1513/AnnalsATS.201305-130OC.

DOI:10.1513/AnnalsATS.201305-130OC

PMID:24079724

Abstract

BACKGROUND

The current oncologic management of non-small cell lung cancer (NSCLC) requires pathologic differentiation between adenocarcinoma and squamous cell carcinoma. Furthermore, novel therapies for adenocarcinoma are clinically available for specific mutation profiles. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been shown to adequately obtain specimens for molecular profiling. However, it remains unclear what quantity of specimens is needed to provide suitable mutational genotyping for adenocarcinoma. The objective of this study was to determine the optimal number of aspirations per EBUS-TBNA procedure required in the presence of rapid on-site cytopathology evaluation (ROSE) for maximal diagnostic yield for molecular mutational analysis.

METHODS

From March 2010 to February 2012, cytopathologic data were collected from consecutive cases of adenocarcinoma or NSCLC not otherwise specified (NSCLC-NOS), diagnosed by EBUS-TBNA and ROSE. Samples of material obtained were air-dried and wet-fixed. Samples were tested for the KRAS, EGFR, and/or ALK mutations.

MEASUREMENTS AND MAIN RESULTS

Eighty-five patients who underwent EBUS-TBNA and were diagnosed with adenocarcinoma or NSCLC-NOS were identified. Of the 85 cases identified, 77 (90.6%) were classified as adenocarcinoma with the remaining 8 (9.4%) classified as NSCLC-NOS. Eighty-one of 85 (95.3%) were found to be adequate for molecular profiling. The median number of sites sampled was one. A median of four passes was needed to obtain adequate molecular profiling of 95.3%, using EBUS in conjunction with ROSE.

CONCLUSIONS

With the use of EBUS-TBNA and ROSE, a minimum of four needle passes may provide an adequate amount of specimen for advanced molecular marker analysis.

摘要

背景

目前，非小细胞肺癌（NSCLC）的肿瘤治疗需要对腺癌和鳞状细胞癌进行病理区分。此外，针对特定突变谱，临床上还可采用新型腺癌治疗方法。支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）已被证明能够充分获取用于分子分析的标本。但是，尚不清楚需要进行多少次 EBUS-TBNA 抽吸才能为腺癌提供合适的基因突变检测。本研究旨在确定在快速现场细胞学评估（ROSE）的情况下，为了获得最大的分子突变分析诊断效果，每例 EBUS-TBNA 操作所需的最佳抽吸次数。

方法

2010 年 3 月至 2012 年 2 月，连续收集经 EBUS-TBNA 和 ROSE 诊断为腺癌或非小细胞肺癌（NSCLC）但未分类（NSCLC-NOS）的病例的细胞学数据。获得的标本经空气干燥和湿固定后进行 KRAS、EGFR 和/或 ALK 基因突变检测。

测量和主要结果

共确定 85 例行 EBUS-TBNA 检查并诊断为腺癌或 NSCLC-NOS 的患者。85 例患者中，77 例（90.6%）为腺癌，8 例（9.4%）为 NSCLC-NOS。85 例中的 81 例（95.3%）被认为可进行分子分析。中位取样部位为 1 个，使用 ROSE 联合 EBUS 进行检测，需 4 次穿刺才能获得 95.3%的足够分子分析。