Bellinger Christina R, Sharma Deepankar, Dotson Travis, Ruiz Jimmy, Parks Graham, Haponik Edward F
From the Wake Forest University School of Medicine, Winston-Salem, and the W.G. (Bill) Hefner Veterans Administration Medical Center, Salisbury, NC.
South Med J. 2018 Oct;111(10):601-606. doi: 10.14423/SMJ.0000000000000869.
Targeted therapies for non-small-cell lung cancers (NSCLCs) are based on the presence of driver mutations such as epidermal growth factor receptor (EGFR) and the echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase (EML4-ALK) translocation. Endobronchial ultrasound-guided-transbronchial needle aspiration (EBUS-TBNA) is a first-line modality for diagnosing and staging NSCLC. A quality improvement protocol maximizing tissue acquisition for molecular analysis has not been previously described.
We instituted a standardized protocol designed from a multidisciplinary meeting of the pulmonology, oncology, and pathology departments for the acquisition and on-site processing of samples obtained through EBUS-TBNA to improve the yield for genetic analysis of EGFR and ALK testing.
Preprotocol there were 50 NSCLCs (29 adenocarcinomas) and postprotocol there were 109 NSCLCs (52 adenocarcinomas). A statistically significant increase in yield for molecular analysis was seen in both EGFR (36% preprotocol and 80% postprotocol, < 0.01) and ALK (41% preprotocol and 80% postprotocol, < 0.01). There was no difference in complications preprotocol and postprotocol.
Implementation of a standardized protocol with EBUS-TBNA was associated with an increase in adequacy for molecular genetic analysis in NSCLC.
非小细胞肺癌（NSCLC）的靶向治疗基于驱动基因突变的存在，如表皮生长因子受体（EGFR）和棘皮动物微管相关蛋白样4-间变性淋巴瘤激酶（EML4-ALK）易位。支气管内超声引导下经支气管针吸活检（EBUS-TBNA）是诊断NSCLC和进行分期的一线方法。此前尚未描述过一种能最大限度获取组织用于分子分析的质量改进方案。
我们制定了一项标准化方案，该方案由肺科、肿瘤科和病理科的多学科会议设计，用于获取通过EBUS-TBNA获得的样本并进行现场处理，以提高EGFR和ALK检测的基因分析成功率。
方案实施前有50例NSCLC（29例腺癌），方案实施后有109例NSCLC（52例腺癌）。EGFR（方案实施前为36%，方案实施后为80%，P<0.01）和ALK（方案实施前为41%，方案实施后为80%，P<0.01）的分子分析成功率均有统计学意义的显著提高。方案实施前后并发症无差异。
实施EBUS-TBNA标准化方案可提高NSCLC分子遗传分析的成功率。
