Diep Raymond, MacDonald Madeline, Cooper Ryan, Grzegorczyk Anna, Rakocevic Rastko, Chang Ching-Fei, Uy Angeline, Cowgill Nicholas, Nieva Jorge J
California University of Science and Medicine School of Medicine, Colton, California.
Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California.
JTO Clin Res Rep. 2023 Mar 11;4(4):100497. doi: 10.1016/j.jtocrr.2023.100497. eCollection 2023 Apr.
Next-generation sequencing (NGS) is essential to the care of patients with NSCLC. Nevertheless, NGS is dependent on adequate material from biopsy. We evaluated the impact of biopsy method and needle gauge necessary for optimizing success in tissue NGS.
A total of 1660 formalin-fixed, paraffin-embedded samples were submitted to Caris Life Sciences from 2007 to 2022 for tumor profiling. The results of NGS assays were linked with retrospective biopsy data for patients with lung cancer treated at USC/Norris Cancer Center to create a database with the following parameters: demographics, biopsy method, tumor location (lung mass versus lymph node versus metastasis), needle gauge, number of needle passes, complications, tumor volume, DNA content, and status of NGS. Fisher's exact test and analysis of variance were performed to determine the impact of biopsy method and needle gauge (G).
In total, 77 computed tomography (CT)-guided transthoracic core needle (CT-TTCN) biopsies, 74 endobronchial ultrasound (EBUS)-guided transbronchial needle aspirations (TBNAs), 27 bronchial forceps biopsies, and 107 surgical resections were included. Furthermore, 41 of 77 CT-TTCN biopsies (53.2%), 43 of 74 EBUS-TBNAs (58.1%), 22 of 27 bronchial forceps biopsies (81.5%), and 105 of 107 surgical resections (98.1%) underwent successful NGS assays. The probability of successful NGS completion for lung cancers was highest in surgical resections and bronchial forceps biopsies. Needle-based biopsies were more successful when a needle larger than 20G was used. Complication rates were higher for CT-TTCN biopsies compared with EBUS-TBNA ( < 0.0001). Overall, the DNA yield was significantly higher in EBUS-TBNA compared with CT-TTCN biopsies in primary lung sites ( = 0.0002). EBUS-TBNA was found to have higher success rates in NGS compared with CT-TTCN for both primary lung lesions ( = 0.023) and lymph node targets ( = 0.035).
The less invasive EBUS-TBNAs had higher success rates in NGS than CT-TTCN biopsies and resulted in higher DNA concentrations. In CT-TTCN biopsies, use of 20G or smaller needles is associated with a higher risk of obtaining an inadequate specimen regardless of the number of passes taken. Surgical and bronchial forceps biopsies had highest success in achieving NGS.
下一代测序（NGS）对于非小细胞肺癌（NSCLC）患者的治疗至关重要。然而，NGS依赖于活检获取的充足样本。我们评估了活检方法和穿刺针规格对优化组织NGS成功率的影响。
2007年至2022年期间，共有1660份福尔马林固定、石蜡包埋的样本被提交至凯瑞斯生命科学公司进行肿瘤分析。将NGS检测结果与南加州大学/诺里斯癌症中心接受治疗的肺癌患者的回顾性活检数据相关联，以创建一个包含以下参数的数据库：人口统计学信息、活检方法、肿瘤位置（肺肿块、淋巴结或转移灶）、穿刺针规格、穿刺次数、并发症、肿瘤体积、DNA含量以及NGS状态。采用Fisher精确检验和方差分析来确定活检方法和穿刺针规格（G）的影响。
总共纳入了77例计算机断层扫描（CT）引导下经胸芯针活检（CT-TTCN）、74例支气管内超声（EBUS）引导下经支气管针吸活检（TBNA）、27例支气管钳取活检以及107例手术切除样本。此外，77例CT-TTCN活检中有41例（53.2%）、74例EBUS-TBNA中有43例（58.1%）、27例支气管钳取活检中有22例（81.5%）以及107例手术切除中有105例（98.1%）成功进行了NGS检测。肺癌NGS检测成功完成的概率在手术切除和支气管钳取活检中最高。当使用大于20G的穿刺针时，基于针吸的活检成功率更高。与EBUS-TBNA相比，CT-TTCN活检的并发症发生率更高（<0.0001）。总体而言，在原发性肺部位，EBUS-TBNA的DNA产量显著高于CT-TTCN活检（=0.0002）。对于原发性肺部病变（=0.023）和淋巴结靶点（=0.035），EBUS-TBNA在NGS检测中的成功率均高于CT-TTCN。
侵入性较小的EBUS-TBNA在NGS检测中的成功率高于CT-TTCN活检，且DNA浓度更高。在CT-TTCN活检中，无论穿刺次数多少，使用20G或更小的穿刺针获取样本不足的风险更高。手术和支气管钳取活检在实现NGS检测方面成功率最高。
