Pulmonary Procedures |

Use of Lymph Node Aspirates From Endobronchial Ultrasound for Multiple Tumor Genotyping Techniques in Non-small Cell Lung Cancer FREE TO VIEW

Erik Folch, MD; Norihiro Yamaguchi, MD; Paul Vanderlaan, MD; Michael Kent, MD; Sidharta Gangadharan, MD; Michael Goldstein, MD; Mark Huberman, MD; Daniel Costa, MD; Adnan Majid, MD
Author and Funding Information

Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA

Chest. 2013;144(4_MeetingAbstracts):813A. doi:10.1378/chest.1705104
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SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 27, 2013 at 03:00 PM - 04:00 PM

PURPOSE: Adequate tumor acquisition is essential to identify somatic molecular alterations in non-small-cell lung cancer (NSCLC). The success and failure rates for tumor genotyping obtained through endobronchial ultrasound (EBUS) and other diagnostic modalities in routine NSCLC care have not been well described. We sought to evaluate the success and failure rates of EGFR mutation, KRAS mutation and ALK FISH from EBUS-derived samples as well as compare them with other

METHODS: Clinico-pathologic data, tumor genotype success and failure rates were retrospectively compiled and analyzed from 207 patient-tumor samples sent for routine tumor genotype in clinical practice, and in specific from 42 patient-tumor samples obtained from hilar or mediastinal lymph nodes using EBUS.

RESULTS: From these 207 patients with lung cancer, with a median age of 65 years, 62.3% women, 77.8% were white, 26.6% were never smokers, and 84.1% had adenocarcinoma histology. The tumor tissue was obtained from EBUS-derived nodes in 42 cases (20.2%). In this latter cohort, the overall success rate for EGFR mutation analysis was 95.2%, for KRAS mutation 90.5% and for ALK FISH 90.5%. In the complete 207 tumors, the success rate for EGFR was 92.3%, for KRAS 91.8% and for ALK FISH 89.9%. The failure rates were not significantly inferior when comparing EBUS-derived nodal tissue versus all other samples (for EGFR 2/42 vs 14/165, p=0.54; for KRAS 4/42 vs 13/165; p=0.75 and for ALK 4/42 vs 17/165; p=1) or versus surgical biopsies of mediastinal nodes. We also found a statistically significant difference in favor of bronchoscopic biopsies vs. image-guided biopsies.

CONCLUSIONS: The success rate of multiple tumor genomic analyses techniques for EGFR, KRAS and ALK gene abnormalities using routine lung cancer tissue samples obtained by means of EBUS exceeds 90%, and this method of tissue acquisition is not inferior to other specimen types. In this series, EBUS-TBNA was superior to other image-guided techniques.

CLINICAL IMPLICATIONS: Tissue samples obtained by EBUS-TBNA may be used for genetic analysis and are comparable or better than other diagnostic techniques.

DISCLOSURE: Daniel Costa: Consultant fee, speaker bureau, advisory committee, etc.: I have received consulting fees from Roche, Pfizer and AstraZeneca The following authors have nothing to disclose: Erik Folch, Norihiro Yamaguchi, Paul Vanderlaan, Michael Kent, Sidharta Gangadharan, Michael Goldstein, Mark Huberman, Adnan Majid

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