Haralsingh Aaron, West Mark
Surgery, Eric Williams Medical Sciences Complex, St. Joseph, TTO.
Cureus. 2021 Jan 6;13(1):e12531. doi: 10.7759/cureus.12531.
Introduction Patients with unresectable non-small cell lung cancer (NSCLC) may benefit from chemotherapy, tyrosine kinase inhibitor (TKI) therapy, or both. TKI therapy may be administered to the subset of patients who harbor the epidermal growth factor receptor (EGFR) mutation. EGFR mutation testing now plays a vital role in the diagnostic work-up of advanced NSCLC patients to determine which patients are more likely to benefit from TKI therapy. The role of surgery in these patients is mostly limited to obtaining an adequate biopsy for histological, immunohistochemical, and EGFR analysis using the least invasive methods possible. It is thought that larger volume samples, such as those obtained from traditional surgical lung biopsies (SLBs), have better yield than small volume samples, such as those obtained from transthoracic needle lung biopsies (TTNLBs), for EGFR analysis. Aim The aim of this was to determine which biopsy procedures provide superior yield for EGFR mutation analysis among primary NSCLC patients at the Eric Williams Medical Sciences Complex (EWMSC) and whether these tissue yields are in keeping with international recommendations. Methods This is a retrospective, observational study using patient data obtained from the Lung Malignancy Unit, which is based at the EWMSC. The study population was limited to primary NSCLC patients presenting to the EWMSC from January 2014 to June 2017 whose biopsy samples were sent for EGFR testing. Relevant patient data were entered onto a spreadsheet using Microsoft Excel. Patients were classified as having had either an SLB, bronchial biopsy (BB), TTNLB, or some other biopsy procedure. All samples were sent for histological analysis, followed by immunohistochemistry and finally EGFR testing. All EGFR mutation analysis was performed at a single laboratory in the USA. A minimum of 200 tumor cells or 10% tumor content defined an adequate sample for EGFR mutation analysis. Samples that yielded a positive or negative result were considered adequate samples in this study. The number of adequate and inadequate samples for each procedure group was tabulated and the yield was determined as the percentage of adequate samples obtained for each procedure group. Results SLBs had superior yield (95.6%) compared to BBs (88.5%) and TTNLB (85%) in obtaining adequate samples for EGFR analysis. Conclusion SLBs demonstrated superior yield in attaining adequate tissue samples for EGFR mutation analysis compared to BBs and TTNLBs.
引言
无法切除的非小细胞肺癌（NSCLC）患者可能从化疗、酪氨酸激酶抑制剂（TKI）治疗或两者联合治疗中获益。TKI治疗可应用于携带表皮生长因子受体（EGFR）突变的患者亚组。EGFR突变检测目前在晚期NSCLC患者的诊断检查中起着至关重要的作用，以确定哪些患者更有可能从TKI治疗中获益。手术在这些患者中的作用主要限于使用尽可能微创的方法获取足够的活检样本，用于组织学、免疫组织化学和EGFR分析。人们认为，对于EGFR分析而言，较大体积的样本，如从传统外科肺活检（SLB）获得的样本，比小体积样本，如从经胸针吸肺活检（TTNLB）获得的样本，具有更高的阳性率。
目的
本研究的目的是确定在埃里克·威廉姆斯医学科学中心（EWMSC），哪些活检程序在原发性NSCLC患者中进行EGFR突变分析时能提供更高的阳性率，以及这些组织阳性率是否符合国际推荐。
方法
这是一项回顾性观察研究，使用从位于EWMSC的肺部恶性肿瘤科获取的患者数据。研究人群仅限于2014年1月至2017年6月就诊于EWMSC的原发性NSCLC患者，其活检样本被送去进行EGFR检测。相关患者数据使用Microsoft Excel录入电子表格。患者被分类为接受了SLB、支气管活检（BB）、TTNLB或其他某种活检程序。所有样本均送去进行组织学分析，随后进行免疫组织化学分析，最后进行EGFR检测。所有EGFR突变分析均在美国的一个实验室进行。至少200个肿瘤细胞或肿瘤含量达10%被定义为适合进行EGFR突变分析的样本。在本研究中，产生阳性或阴性结果的样本被视为合格样本。将每个程序组的合格和不合格样本数量制成表格，并将阳性率确定为每个程序组获得的合格样本百分比。
结果
在获取用于EGFR分析的合格样本方面，SLB的阳性率（95.6%）高于BB（88.5%）和TTNLB（85%）。
结论
与BB和TTNLB相比，SLB在获取用于EGFR突变分析的足够组织样本方面显示出更高的阳性率。
