Stevenson Tracey, Powari Manish, Bowles Christopher
Consultant Biomedical Scientist, Cellular Pathology, RDE NHSFT, Exeter, Devon, United Kingdom.
Consultant Pathologist, RDE NHSFT, Exeter, Devon, United Kingdom.
Diagn Cytopathol. 2018 Aug;46(8):656-662. doi: 10.1002/dc.23967. Epub 2018 May 13.
Endobronchial ultrasound fine needle aspiration (EBUS FNA) is a well-established procedure for the diagnosis and staging of lung cancer. We review our provision of this service at the Royal Devon and Exeter NHS Foundation Trust and the role of rapid onsite evaluation (ROSE) with the increasing demand for molecular markers in this era of personalized medicine.
A review of the changes in the Endoscopy clinic over the 7 years from the introduction of EBUS at the end of 2010 until 2017 was carried out. This included the availability of material obtained for diagnosis, accurate subtyping, and molecular testing. We also assessed the success of molecular genetics DNA techniques from EBUS material versus formalin fixed paraffin embedded tissue (FFPE).
A total of 1218 EBUS cases with ROSE were reported between 2011 and 2017 Percentage diagnostic rates were calculated as 83, 82, 84, 92, 93, 94, and 92 for 2011, 2012, 2013, 2014, 2015, 2016, and 2017, respectively. Availability of material for immunocytochemistry ranged from 86 to 100% over the 7 years. Molecular testing was successfully performed for EGFR in 89-100% of requested cases and ALK testing in 87-100% of requested cases. EBUS sourced material gave on average twice the amount of DNA and fewer amplicon repeats per patient compared to FFPE material.
ROSE at EBUS FNA provides access to suitable material for molecular testing with increased yields in the form of needle washings for EGFR with FFPE materials for ALK and PDL1 testing.
支气管内超声引导针吸活检术（EBUS FNA）是一种成熟的肺癌诊断和分期方法。我们回顾了英国皇家德文郡和埃克塞特国民保健服务基金会信托基金提供此项服务的情况，以及在这个个性化医疗时代，随着对分子标志物需求的增加，快速现场评估（ROSE）所起的作用。
对2010年底引入EBUS至2017年这7年间内镜诊所的变化进行了回顾。这包括用于诊断的取材情况、准确的亚型分类以及分子检测。我们还评估了从EBUS取材获得的分子遗传学DNA技术与福尔马林固定石蜡包埋组织（FFPE）相比的成功率。
2011年至2017年共报告了1218例接受ROSE的EBUS病例。2011年、2012年、2013年、2014年、2015年、2016年和2017年的诊断率分别计算为83%、82%、84%、92%、93%、94%和92%。7年间免疫细胞化学取材率在86%至100%之间。在89% - 100%的申请病例中成功进行了表皮生长因子受体（EGFR）分子检测，在87% - 100%的申请病例中成功进行了间变性淋巴瘤激酶（ALK）检测。与FFPE材料相比，EBUS取材平均每位患者获得的DNA量是其两倍，且扩增子重复次数更少。
EBUS FNA中的ROSE可为分子检测提供合适的取材，以针吸冲洗液形式用于EGFR检测，以FFPE材料形式用于ALK和程序性死亡受体1（PDL1）检测，取材量有所增加。
