Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
Lung Cancer. 2014 Apr;84(1):39-44. doi: 10.1016/j.lungcan.2014.01.013. Epub 2014 Jan 28.
Identification of some somatic molecular alterations in non-small-cell lung cancer (NSCLC) has become evidence-based practice. The success and failure rate of using commercially available tumor genotyping techniques in routine day-to-day NSCLC pathology samples is not well described. We sought to evaluate the success and failure rate of EGFR mutation, KRAS mutation, and ALK FISH in a cohort of lung cancers subjected to routine clinical tumor genotype.
Clinicopathologic data, tumor genotype success and failure rates were retrospectively compiled and analyzed from 381 patient-tumor samples.
From these 381 patients with lung cancer, the mean age was 65 years, 61.2% were women, 75.9% were white, 27.8% were never smokers, 73.8% had advanced NSCLC and 86.1% had adenocarcinoma histology. The tumor tissue was obtained from surgical specimens in 48.8%, core needle biopsies in 17.9%, and as cell blocks from aspirates or fluid in 33.3% of cases. Anatomic sites for tissue collection included lung (49.3%), lymph nodes (22.3%), pleura (11.8%), bone (6.0%), brain (6.0%), among others. The overall success rate for EGFR mutation analysis was 94.2%, for KRAS mutation 91.6% and for ALK FISH 91.6%. The highest failure rates were observed when the tissue was obtained from image-guided percutaneous transthoracic core-needle biopsies (31.8%, 27.3%, and 35.3% for EGFR, KRAS, and ALK tests, respectively) and bone specimens (23.1%, 15.4%, and 23.1%, respectively). In specimens obtained from bone, the failure rates were significantly higher for biopsies than resection specimens (40% vs. 0%, p=0.024 for EGFR) and for decalcified compared to non-decalcified samples (60% vs. 5.5%, p=0.021 for EGFR).
Tumor genotype techniques are feasible in most samples, outside small image-guided percutaneous transthoracic core-needle biopsies and bone samples from core biopsies with decalcification, and therefore expansion of routine tumor genotype into the care of patients with NSCLC may not require special tissue acquisition or manipulation.
非小细胞肺癌（NSCLC）中某些体细胞分子改变的鉴定已成为循证实践。在常规的 NSCLC 病理样本中使用市售肿瘤基因分型技术的成功率和失败率尚未得到很好的描述。我们试图评估 EGFR 突变、KRAS 突变和 ALK FISH 在接受常规临床肿瘤基因型检测的肺癌患者队列中的成功率和失败率。
回顾性地从 381 例患者-肿瘤样本中收集临床病理数据、肿瘤基因型成功率和失败率，并进行分析。
这些 381 例肺癌患者的平均年龄为 65 岁，61.2%为女性，75.9%为白人，27.8%为从不吸烟者，73.8%为晚期 NSCLC，86.1%为腺癌组织学类型。肿瘤组织取自手术标本（48.8%）、芯针活检（17.9%）和抽吸或液体的细胞块（33.3%）。组织采集的解剖部位包括肺（49.3%）、淋巴结（22.3%）、胸膜（11.8%）、骨（6.0%）、脑（6.0%）等。EGFR 突变分析的总体成功率为 94.2%，KRAS 突变分析为 91.6%，ALK FISH 分析为 91.6%。当组织来自影像引导经皮穿刺肺芯针活检（EGFR、KRAS 和 ALK 检测的失败率分别为 31.8%、27.3%和 35.3%）和骨标本（分别为 23.1%、15.4%和 23.1%）时，失败率最高。在骨标本中，活检的失败率明显高于切除术标本（EGFR 为 40%比 0%，p=0.024），脱钙样本的失败率明显高于未脱钙样本（EGFR 为 60%比 5.5%，p=0.021）。
肿瘤基因型技术在外周小影像引导经皮穿刺肺芯针活检和经芯针活检获得的骨样本中可行，并且无需特殊的组织采集或处理即可将常规肿瘤基因型检测扩展到 NSCLC 患者的治疗中。
