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Takahiro Nakajima, MD, PhD; Kazuhiro Yasufuku, MD, PhD, FCCP
Author and Funding Information

From the Division of Thoracic Surgery, Toronto General Hospital, University Health Network.

Correspondence to: Kazuhiro Yasufuku, MD, PhD, FCCP, Interventional Thoracic Surgery Program, University of Toronto, Division of Thoracic Surgery, Toronto General Hospital, University Health Network, 200 Elizabeth St, 9N-957, Toronto, ON, M5G 2C4, Canada; e-mail: Kazuhiro.Yasufuku@uhn.ca

Financial/nonfinancial disclosures: Dr Yasafuku has received unrestricted grants from Olympus medical systems for continuing medical education. Dr Nakajima has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Financial/nonfinancial disclosures: Dr Yasafuku has received unrestricted grants from Olympus medical systems for continuing medical education. Dr Nakajima has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Financial/nonfinancial disclosures: Dr Yasafuku has received unrestricted grants from Olympus medical systems for continuing medical education. Dr Nakajima has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Chest. 2011;140(6):1664-1665. doi:10.1378/chest.11-1319
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To the Editor:

We thank Dr Fleury-Feith and colleagues for their interest in our recent article in CHEST1 on the use of endobronchial ultrasound-guided transbronchial needle aspiration samples for multigene mutation analysis. Screening for oncogenic gene alteration in non-small cell lung cancer is becoming an important factor in targeted therapy for lung cancer. The ability to acquire surgically resected lung cancer tissue is limited because the majority of patients with lung cancer are inoperable at the time of presentation. Hence, molecular testing using diagnostic biopsy samples is important for the accurate selection of patients who will benefit from targeted therapy. In our study, the cell pellet derived from a needle wash solution and stored frozen samples were used to avoid the risk of false-positive results due to the fragmented and low amount of DNA.1 As Dr Fleury-Feith and colleagues suggest, using frozen cells will ensure current optimum technical conditions.

On the other hand, there have been very few articles on the optimal storing methods for samples obtained by needle biopsy techniques for molecular testing. The development of an optimal specimen-handling technique and tumor banking protocol for molecular testing is mandatory for personalized treatment based on biomarker-driven information.2 Although we agree with the importance of the collection and analysis of fresh-frozen samples from endobronchial ultrasound-guided transbronchial needle aspiration, this may not always be possible in a community hospital. There is a need to develop a reliable, high-throughput analysis using formalin-fixed paraffin-embedded samples. The MassARRAY system (Sequenom Inc; San Diego, California) and molecular inversion probe microarrays may be powerful tools for the detection of comprehensive aberrant gene mutation within lung cancer.3,4

In conclusion, we are witnessing a paradigm shift in targeted cancer therapy using selective kinase inhibitor in patients with lung cancer. In addition to the exploration of a novel target molecule, we need to continuously seek a better way to sample and preserve microsamples for molecular analysis.

Nakajima T, Yasufuku K, Nakagawara A, Kimura H, Yoshino I. Multigene mutation analysis of metastatic lymph nodes in non-small cell lung cancer diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration. Chest. 2011;1405:1319-1324 [CrossRef] [PubMed]
 
Nakajima T, Yasufuku K. How I do it—optimal methodology for multidirectional analysis of endobronchial ultrasound-guided transbronchial needle aspiration samples. J Thorac Oncol. 2011;61:203-206 [CrossRef]
 
Pao W, Kris MG, Iafrate AJ, et al. Integration of molecular profiling into the lung cancer clinic. Clin Cancer Res. 2009;1517:5317-5322 [CrossRef]
 
Wang Y, Carlton VE, Karlin-Neumann G, et al. High quality copy number and genotype data from FFPE samples using Molecular Inversion Probe (MIP) microarrays. BMC Med Genomics. 2009;2:8 [CrossRef]
 

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References

Nakajima T, Yasufuku K, Nakagawara A, Kimura H, Yoshino I. Multigene mutation analysis of metastatic lymph nodes in non-small cell lung cancer diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration. Chest. 2011;1405:1319-1324 [CrossRef] [PubMed]
 
Nakajima T, Yasufuku K. How I do it—optimal methodology for multidirectional analysis of endobronchial ultrasound-guided transbronchial needle aspiration samples. J Thorac Oncol. 2011;61:203-206 [CrossRef]
 
Pao W, Kris MG, Iafrate AJ, et al. Integration of molecular profiling into the lung cancer clinic. Clin Cancer Res. 2009;1517:5317-5322 [CrossRef]
 
Wang Y, Carlton VE, Karlin-Neumann G, et al. High quality copy number and genotype data from FFPE samples using Molecular Inversion Probe (MIP) microarrays. BMC Med Genomics. 2009;2:8 [CrossRef]
 
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