1295P - Role of CT-guided lung biopsy in the era of personalized medicine - an effective and safe tissue acquisition for specific subytping and molecular di...

Date 29 September 2012
Event ESMO Congress 2012
Session Poster presentation I
Topics Non-Small-Cell Lung Cancer, Metastatic
Imaging, Diagnosis and Staging
Presenter Shih-Hsin Hsiao
Authors S. Hsiao1, C. Chung1, S. Lin2
  • 1Division Of Pulmonary Medicine, Department Of Internal Medicine, Taipei Medical University Hospital, Taipei, 110 - Taipei/TW
  • 2Department Of Pathology, Taipei Medical University Hospital, Taipei, 110 - Taipei/TW

Abstract

Purpose

Recent several phase III clinial trials have demonstrated that determination of histological subtypes and molecular genotypes of non-small cell lung cancer (NSCLC) is very crucial in personalized medicine. One of the most debates in this issue is how to achive optimal tumor samples. We sought to examine the efficacy, safety of computed tomography (CT)-guided lung biopsy and the suitability of the obtaind tumor tissues for epidermal growth factor receptor (EGFR) mutational testing.

Patients and methods

Clinicopathological data of 305 consecutive patients undergoing CT-guided core biopsies for lung lesions were retrospectively reviewed for the period between January 2007 and December 2011 under the approval of institutional review board. Additionally, 128 residual tumor tissues were examined for the suitabilitiy, efficacy and results of EGFR mutation analyses.

Results

Among a total 321 CT-guided lung biopies, 98% provided adequate tissues for histological anayses, with 72% as malignancy and 26% as benigh diagnoses. The sensitivity and specificity of malignancy diagosis were 92% and 100%, respectively. As to the complicatons, the rates of procedure-related immediate and delayed pneumothorax, hemoptysis and mortality were 28%, 10%, 3%, and none, respectively. Only 6% (20/321) of lung biopsies led to pneumothorax needing a chest tube-guided air drainage, significanly associated with the number of biopsy cuts (OR = 3.12, 95% CI = 1.39-7.03, p = 0.006). Of 203 diagnoses as NSCLC category, up to 91% were specifically subtyped as adenocarcinoma (79%) and squamous cell carcinoma (12%), and the remaining were not otherwise specified (9%). In total, 128 residual tumor tissues with diagnosis of NSCLC were submitted for EGFR mutational testing under the clinicians' reguest, and 126 (98.4%) were eligible after pathologist's review. Conclusive results of EGFR tests were achived in 124 (98.4%) of 126 identified samples, indicating 63% with EGFR exon 18-21 mutations.

Conclusion

We demonstrate that CT-guided lung biopsy provides adequate tissues for histological analyses with high sensitivity and specificity of malignancy diagnosis, and for subyping NSCLC and EGFR molecular testing; its complications are limited and manageable.

Disclosure

All authors have declared no conflicts of interest.