Kim Mi-Hyun, Seong Hayoung, Jang Hyojin, Kim Saerom, Yoo Wanho, Kim Soo Han, Mok Jeongha, Lee Kwangha, Kim Ki Uk, Lee Min Ki, Eom Jung Seop
Department of Internal Medicine, Pusan National University, School of Medicine, Busan, Korea.
Department of Internal Medicine, Pusan National University Hospital, Busan, Korea.
Cancer Res Treat. 2025 Feb 26. doi: 10.4143/crt.2024.1128.
There have been efforts to find alternative samples other than standard samples of tissue or plasma for mutational analyses for lung cancer patients. However, no other sample or technique has replaced the mutational analyses using standard samples. In this prospective study, we assessed a novel bronchoscopy method, named as targeted washing technique, for detecting the EGFR mutation.
A 3.0-mm ultrathin bronchoscope was precisely navigated to the target lung lesion with the assistance of virtual bronchoscopic navigation and fluoroscopy. Once the bronchoscope is placed in front of target lung lesion, 0.9% normal saline was instilled for targeted washing. EGFR testing using targeted washing fluid (TWF) was compared to standard methods using plasma or tumor tissue.
In 41 TWF samples, the T790M mutation was detected in tissue, plasma, and TWF samples at rates of 22%, 10%, and 29%, respectively. The overall EGFR T790M detection rate using tissue, plasma, or TWF samples was 37%, with TWF samples increasing the T790M mutation detection rate by up to 10%. The accuracy of T790M mutation detection using TWF sample was 83% compared with standard samples. Four patients were found to have the EGFR T790M mutation solely through EGFR testing using TWF, which repeated rebiopsies using either plasma or tissue finally confirmed to have the T790M mutation.
We demonstrated the clinical potential of targeted washing technique for molecular testing, which can be a good option to overcome spatial heterogeneity, low sensitivity of plasma sample or technical limitations in collecting tumor tissues.
人们一直在努力寻找肺癌患者突变分析的标准组织或血浆样本之外的替代样本。然而，没有其他样本或技术能够取代使用标准样本进行的突变分析。在这项前瞻性研究中，我们评估了一种名为靶向冲洗技术的新型支气管镜检查方法用于检测表皮生长因子受体（EGFR）突变。
在虚拟支气管镜导航和荧光透视的辅助下，将一根3.0毫米的超细支气管镜精确地导航至目标肺部病变处。一旦支气管镜置于目标肺部病变前方，注入0.9%的生理盐水进行靶向冲洗。将使用靶向冲洗液（TWF）进行的EGFR检测与使用血浆或肿瘤组织的标准方法进行比较。
在41份TWF样本中，组织、血浆和TWF样本中T790M突变的检测率分别为22%、10%和29%。使用组织、血浆或TWF样本的EGFR T790M总体检测率为37%，TWF样本使T790M突变检测率提高了10%。与标准样本相比，使用TWF样本检测T790M突变的准确率为83%。发现4例患者仅通过使用TWF的EGFR检测发现EGFR T790M突变，最终经血浆或组织重复活检确诊为T790M突变。
我们证明了靶向冲洗技术在分子检测方面的临床潜力，它可以成为克服空间异质性、血浆样本低敏感性或肿瘤组织采集技术局限性的良好选择。
