Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Centre, Seoul, Korea.
Department of Radiology, Institute of Medical Science, and Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea.
Eur Radiol. 2018 Feb;28(2):861-868. doi: 10.1007/s00330-017-5006-6. Epub 2017 Aug 7.
To find predictors of non-diagnostic repeat biopsy specimen acquisition for mutational analysis and detection of epidermal growth factor receptor (EGFR) T790M mutation.
We retrospectively reviewed 90 non-small cell lung cancer patients harbouring EGFR mutations who underwent repeat cone-beam CT-guided transthoracic needle biopsy. Clinical characteristics as well as biopsy-related factors were compared between patients with and without diagnostic specimen acquisition and between patients with and without T790M mutation. After univariate analysis, multivariate logistic regression analysis was performed to reveal independent predictors.
Diagnostic biopsy specimens for mutational test were obtained in 90% (81/90) of patients, of which 62% (50/81) possessed T790M mutation. None of the analysed variables were significantly associated with non-diagnostic specimen acquisition. For T790M detection, duration of EGFR tyrosine kinase inhibitor treatment (p = 0.066), duration of total chemotherapy (p = 0.026), tumour size (p = 0.066), and metastatic lung lesion as a biopsy target (p = 0.029) showed p values less than 0.10. Multivariate analysis revealed that target tumour size (odds ratio, 0.765; p = 0.031) was an independent predictor of T790M mutation. Metastatic lesions as biopsy targets (odds ratio, 4.194; p = 0.050) showed marginal statistical significance.
Non-diagnostic repeat biopsy specimen acquisition was not related to the clinical or technical factors. However, detection of T790M at repeat biopsy might be associated with smaller target tumour size and selection of metastatic lesions as biopsy targets.
• Cone-beam CT-guided repeat biopsy yielded high diagnostic specimen acquisition rate. • Biopsy-related features were associated with the detection of T790M mutation. • Target tumour size was an independent predictor of the T790M detection. • Biopsy targeting metastatic lung nodules might help detect the T790M mutation.
寻找非诊断性重复活检标本获取用于突变分析和检测表皮生长因子受体（EGFR）T790M 突变的预测因子。
我们回顾性分析了 90 例携带 EGFR 突变的非小细胞肺癌患者，这些患者接受了重复的锥形束 CT 引导经胸针吸活检。比较了有和无诊断性标本采集的患者以及有和无 T790M 突变的患者之间的临床特征和活检相关因素。在单因素分析后，进行多变量逻辑回归分析以揭示独立的预测因子。
90%（81/90）的患者获得了用于突变检测的诊断性活检标本，其中 62%（50/81）存在 T790M 突变。分析的变量均与非诊断性标本采集无显著相关性。对于 T790M 的检测，EGFR 酪氨酸激酶抑制剂治疗的持续时间（p=0.066）、总化疗持续时间（p=0.026）、肿瘤大小（p=0.066）和转移性肺病变作为活检靶标（p=0.029）的 p 值均小于 0.10。多变量分析显示，靶肿瘤大小（比值比，0.765；p=0.031）是 T790M 突变的独立预测因子。作为活检靶标的转移性病变（比值比，4.194；p=0.050）具有边缘统计学意义。
非诊断性重复活检标本采集与临床或技术因素无关。然而，重复活检中 T790M 的检测可能与靶肿瘤较小以及选择转移性病变作为活检靶标有关。
锥形束 CT 引导重复活检获得了较高的诊断性标本采集率。
活检相关特征与 T790M 突变的检测有关。
靶肿瘤大小是 T790M 检测的独立预测因子。
活检靶向转移性肺结节可能有助于检测 T790M 突变。
