Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan.
Department of Pulmonology, Kameda Medical Center, Kamogawa, Japan.
BMC Pulm Med. 2020 Sep 9;20(1):238. doi: 10.1186/s12890-020-01277-6.
Patients treated for non-squamous (non-Sq) non-small cell lung cancer (NSCLC) often require repeat biopsies to determine the optimal subsequent treatment. However, the differences between rebiopsy and initial biopsy in terms of their diagnostic yields and their ability to test the molecular profiles using bronchoscopy with radial endobronchial ultrasound guidance in patients with advanced NSCLC remain unclear. Hence, we aimed to compare the diagnostic yields and ability for molecular analyses of rebiopsies with those of initial biopsies.
We investigated 301 patients with advanced non-Sq NSCLC who underwent radial endobronchial ultrasound-guided transbronchial biopsy (TBB) for peripheral pulmonary lesions (PPLs) between August 2014 and July 2017. Patients were divided into the rebiopsy and initial biopsy groups: the latter referred to the biopsy that determined the definitive diagnosis. The diagnostic yields and ability for molecular analyses were compared between the two groups, and the factors affecting the TBB diagnostic yield were identified using univariate and multivariate analyses.
The diagnostic yields of the rebiopsy and initial biopsy groups were comparable (86.8 and 90.8%, respectively; p = 0.287). Furthermore, 93.0 and 94.0% of the patients in the rebiopsy and initial biopsy groups, respectively, had adequate specimens for gene profiling and mutational analysis (p = 0.765). The factors that increased the diagnostic yield were a positive bronchus sign (p < 0.001) and tumour location within the internal two-thirds of the lungs (p = 0.026).
The PPL diagnostic yield of the rebiopsy group was as high as that of the initial biopsy group. Hence, TBB for PPLs is feasible for patients requiring rebiopsy as well as for those with initial diagnoses. Adequate, high-quality biopsy specimens can be obtained by transbronchial rebiopsy for molecular testing.
接受非鳞状（非 Sq）非小细胞肺癌（NSCLC）治疗的患者通常需要重复进行活检以确定最佳的后续治疗方案。然而，在接受高级别 NSCLC 治疗的患者中，经支气管镜径向超声引导下重复活检与初始活检相比，在诊断率和检测分子谱的能力方面存在差异尚不清楚。因此，我们旨在比较重复活检与初始活检的诊断率和分子分析能力。
我们调查了 2014 年 8 月至 2017 年 7 月期间，301 名接受经支气管镜径向超声引导下经支气管活检（TBB）检查外周肺部病变（PPL）的晚期非 Sq NSCLC 患者。患者分为重复活检组和初始活检组：后者是指确定明确诊断的活检。比较两组的诊断率和分子分析能力，并使用单因素和多因素分析确定影响 TBB 诊断率的因素。
重复活检组和初始活检组的诊断率相似（分别为 86.8%和 90.8%；p=0.287）。此外，重复活检组和初始活检组的患者分别有 93.0%和 94.0%的患者有足够的标本进行基因谱分析和突变分析（p=0.765）。增加诊断率的因素是支气管征阳性（p<0.001）和肿瘤位于肺内三分之二以内（p=0.026）。
重复活检组的 PPL 诊断率与初始活检组一样高。因此，对于需要重复活检的患者以及初始诊断的患者，经支气管镜 TBB 是可行的。通过经支气管重复活检可以获得足够、高质量的活检标本进行分子检测。
