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Lung Cancer |

Non-small Cell Lung Cancer Molecular Genetic Yield With Small Volume Samples

Christina Bellinger; Travis Dotson, MD; Jimmy Ruiz, MD
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Wake Forest Baptist Health, Winston Salem, NC


Chest. 2015;148(4_MeetingAbstracts):558A. doi:10.1378/chest.2273999
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Abstract

SESSION TITLE: Lung Cancer Screening & Diagnosis Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Non-small cell lung cancer (NSCLC) is no longer a single disease, but a constellation of morphologically and genetically different cancer subtypes. A fundamental first step in diagnosis is the retrieval of adequate tissue for histological classification and molecular marker evaluation. Molecular genetic yields from various small volume samples in the literature range from 46%-100%. The purpose of this study is to evaluate small volume sample yields with respect to molecular subtype and genetic mutational status of patients with NSCLC.

METHODS: We reviewed a sampling of patients who entered our Thoracic Oncology Program over a three year period (n=151). We performed chart review with particular attention to the histology of NSCLC and whether there was adequate tissue available for molecular genetic testing.

RESULTS: One hundred fifty one patients underwent 229 procedures, of which 156 were small volume diagnostic procedures(71 transthoracic fine needle aspirations [TTFNAs], 46 endobronchial ultrasound-guided transbronchial needle aspirations [EBUS-TBNAs], 5 conventional TBNAs, 8 electromagnetic navigation bronchoscopy [ENB] FNAs, 5 endoscopic ultrasound-guided [EUS]-FNAs, 3 other site FNAs, and 14 thoracentesis). Overall there were 133 NSCLC with 58% adenocarcinomas, 35% squamous cells and 6% NOS. In 88% of patients, the initial procedure was diagnostic. The overall malignant yield for the small volume proceudres was 89%, and cumulative molecular genetic yield was 71% for ALK (anaplastic lymphoma kinase) and 73% for EGFR (epidermal growth factor receptor). Combined complications from these procedures was 7%, all of which were pneumothoraces requiring chest tubes.

CONCLUSIONS: The goals of minimizing risk and maximizing benefit can be challenging in the era of personalized medicine. Our results support that small volume diagnostic procedures often contain sufficient material for immunohistochemical differentiation and molecular testing.

CLINICAL IMPLICATIONS: Minimally invasive modalities can provide sufficient material for immunohistochemical subtyping and genetic markers. These diagnostic modalities allow for the acquisition of small volumes of material while carrying a relatively low risk of complications. This is important in a cohort of patients that often have medical comorbidities including chronic obstructive lung disease (COPD), emphysema and coronary artery disease. Small volume sampling should be pursued before more invasive testing and when surgery is not considered first line.

DISCLOSURE: The following authors have nothing to disclose: Christina Bellinger, Travis Dotson, Jimmy Ruiz

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