Lin Zeyun, Tang Jiaxin, Tan Anzi, Tang Shiqi, Li Yuqin, Gu Yingying, Liu Chunping, Li Mengshi, Chen Zhucheng, Chen Yuying, Zhang Yuxin, He Ping, Deng Qiuhua, Liang Wenhua, He Jianxing, Jiang Juhong
Department of Pathology, Guangzhou Development District Hospital, Guangzhou, China.
State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
J Thorac Dis. 2025 Jul 31;17(7):4782-4793. doi: 10.21037/jtd-2025-521. Epub 2025 Jul 18.
Core needle biopsy (CNB) is commonly used for histological diagnosis and molecular testing in patients with non-small cell lung cancer (NSCLC). However, the adequacy of CNB specimens is often compromised by low tumor cell content or insufficient nucleic acid quantity, which can negatively impact the success of downstream analyses. Moreover, variations in specimen collection techniques may further contribute to inconsistency in sample quality. This retrospective study aimed to assess and optimize CNB specimen collection methods to improve sample adequacy for molecular testing in NSCLC.
A total of 546 CNB specimens from NSCLC patients were collected using three different techniques: (I) steam sterilization indicator cards; (II) polypropylene microporous membranes (PPMM) pieces for tissue adherence; and (III) direct rinsing of biopsy needles with sterilized buffer. Cell pellets were harvested from the residual fixative medium after CNB processing. Tumor cellularity was evaluated in formalin-fixed paraffin-embedded (FFPE) tissues and cell pellet samples from each method.
Adequacy rates for molecular testing were 86.4% in FFPE samples and 92.3% in cell pellet samples. Incorporating cell pellet analysis increased overall molecular testing adequacy to 95.2%. Among the evaluated techniques, the steam sterilization indicator cards cohort yielded the lowest adequacy rates for both FFPE and cell pellet samples. The PPMM technique achieved the highest adequacy for FFPE tissues, while the direct needle rinsing technique provided the highest DNA yields in cell pellet samples. Further, cell pellets demonstrated increased sensitivity for detecting actionable mutations compared to plasma-based liquid biopsies.
The use of PPMMs significantly enhances CNB specimen quality and molecular testing adequacy in NSCLC. Routine collection of cell pellets from the residual fixative medium is recommended to maximize diagnostic effectiveness and improve clinical decision-making.
在非小细胞肺癌（NSCLC）患者中，粗针穿刺活检（CNB）常用于组织学诊断和分子检测。然而，CNB标本的充足性常常因肿瘤细胞含量低或核酸量不足而受到影响，这可能会对下游分析的成功产生负面影响。此外，标本采集技术的差异可能会进一步导致样本质量的不一致。这项回顾性研究旨在评估和优化CNB标本采集方法，以提高NSCLC分子检测的样本充足性。
使用三种不同技术收集了总共546例NSCLC患者的CNB标本：（I）蒸汽灭菌指示卡；（II）用于组织粘附的聚丙烯微孔膜（PPMM）片；（III）用无菌缓冲液直接冲洗活检针。CNB处理后，从残留固定剂培养基中收获细胞沉淀。对每种方法的福尔马林固定石蜡包埋（FFPE）组织和细胞沉淀样本中的肿瘤细胞含量进行评估。
FFPE样本的分子检测充足率为86.4%，细胞沉淀样本的充足率为92.3%。纳入细胞沉淀分析使总体分子检测充足率提高到95.2%。在评估的技术中，蒸汽灭菌指示卡组的FFPE和细胞沉淀样本的充足率最低。PPMM技术在FFPE组织中实现了最高的充足率，而直接针冲洗技术在细胞沉淀样本中提供了最高的DNA产量。此外，与基于血浆的液体活检相比，细胞沉淀在检测可操作突变方面表现出更高的敏感性。
PPMM的使用显著提高了NSCLC中CNB标本质量和分子检测充足率。建议常规从残留固定剂培养基中收集细胞沉淀，以最大限度地提高诊断效果并改善临床决策。
