Suitability of endobronchial ultrasound-guided transbronchial needle aspiration specimens for subtyping and genotyping of non-small cell lung cancer: a multicenter study of 774 patients.
Suitability of endobronchial ultrasound-guided transbronchial needle aspiration specimens for subtyping and genotyping of non-small cell lung cancer: a multicenter study of 774 patients.
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DOI：
10.1164/rccm.201202-0294oc
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发表时间：
2012-06-15
影响因子：
24.7
通讯作者：
Janes SM
中科院分区：
文献类型：
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作者：
Navani N;Brown JM;Nankivell M;Woolhouse I;Harrison RN;Jeebun V;Munavvar M;Ng BJ;Rassl DM;Falzon M;Kocjan G;Rintoul RC;Nicholson AG;Janes SM
目前晚期非小细胞肺癌（NSCLC）的治疗需要区分鳞状和非鳞状亚型以及表皮生长因子受体（EGFR）突变状态。支气管内超声引导下经支气管针吸活检（EBUS-TBNA）越来越多地用于肺癌的诊断和分期。然而，目前尚不清楚EBUS-TBNA获得的细胞学标本是否适合NSCLC的亚分类和基因分型。确定常规实践中从 EBUS-TBNA 获得的细胞学标本是否适合 NSCLC 表型和基因分型。 2009 年至 2011 年间，英国 5 个中心的 774 名已知或疑似肺癌患者记录了 EBUS-TBNA 的细胞学诊断。通过 EBUS-TBNA 最终诊断的亚型患者比例为 77%（95% CI 73% - 80%）。在接受免疫组织化学检查的患者中，未另行指定的 NSCLC (NSCLC-NOS) 发生率显着降低（调整后 OR 0.50 95% CI 0.28 – 0.82，P=0.016）。在 119 名需要进行突变分析的患者中，有 107 名 (90%) 可以进行 EGFR 突变分析。 EBUS-TBNA对NSCLC患者的敏感性、阴性预测值和诊断准确性分别为88%（95% CI 86% - 91%）、72%（95% CI 66% - 77%）和91%（95% CI 89% - 93%）。这项大型多中心务实研究表明，常规实践中从 EBUS-TBNA 获得的细胞学样本适用于 NSCLC 分型和 EGFR 突变分析，并且免疫组织化学的使用可降低 NSCLC-NOS 的发生率。
The current management of advanced non-small cell lung cancer (NSCLC) requires differentiation between squamous and non-squamous sub-types as well as epidermal growth factor receptor (EGFR) mutation status. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is increasingly used for the diagnosis and staging of lung cancer. However, it is unclear whether cytology specimens obtained with EBUS-TBNA are suitable for the sub-classification and genotyping of NSCLC. To determine whether cytology specimens obtained from EBUS-TBNA in routine practice are suitable for phenotyping and genotyping of NSCLC. Cytological diagnoses from EBUS-TBNA were recorded from 774 patients with known or suspected lung cancer across 5 centres in the United Kingdom between 2009 and 2011. The proportion of patients with a final diagnosis by EBUS-TBNA in whom subtype was classified was 77% (95% CI 73% - 80%). The rate of NSCLC not otherwise specified (NSCLC-NOS) was significantly reduced in patients who underwent immunohistochemistry (adjusted OR 0.50 95% CI 0.28 – 0.82, P=0.016). EGFR mutation analysis was possible in 107 (90%) of the 119 patients in whom mutation analysis was requested. The sensitivity, negative predictive value and diagnostic accuracy of EBUS-TBNA in patients with NSCLC was 88% (95% CI 86% - 91%), 72% (95% CI 66% - 77%) and 91% (95% CI 89% - 93%) respectively. This large multi-centre pragmatic study demonstrates that cytology samples obtained from EBUS-TBNA in routine practice are suitable for sub-typing of NSCLC and EGFR mutation analysis and that use of immunohistochemistry reduces the rate of NSCLC-NOS.