Determining factors of endobronchial ultrasound-guided transbronchial needle aspiration specimens for lung cancer subtyping and molecular testing
Determining factors of endobronchial ultrasound-guided transbronchial needle aspiration specimens for lung cancer subtyping and molecular testing
复制标题
支气管内超声引导下经支气管针吸标本用于肺癌分型和分子检测的确定因素
DOI：
10.4103/eus.eus_8_19
复制
发表时间：
2019-11-01
影响因子：
4.5
通讯作者：
Sun, Jiayuan
中科院分区：
文献类型：
--
作者：
Zhang, Yujun;Xie, Fangfang;Sun, Jiayuan
目的：探讨经纤维支气管镜下超声引导下经纤维支气管镜活检(EBUS-TBNA)标本经免疫组织化学(IHC)分型后检测表皮生长因子受体(EGFR)突变和间变性淋巴瘤激酶(ALK)融合的决定因素。材料和方法：对2015年1月至2016年3月在上海胸科医院就诊的疑似晚期肺癌患者行EBUS-TBNA检查，未进行现场快速评估(ROSE)。所有经组织病理学诊断为肺癌的样本均行免疫组化检查以确定亚型。使用残留组织样本检测了腺癌和非小细胞肺癌(NSCLC-NOS)中的EGFR突变和ALK融合。结果：共确诊肺癌453例，其中腺癌占44.15%(200/453)，NSCLC-NOS占11.04%(50/453)。EBUS-TBNA获得的样本平均通过3.41±0.68次，80.4%(201/250)的样本可以进行EGFR突变和ALK融合基因分析。在单因素分析中，分子检测的成功与每个病变的通过次数(P=3.80E-05)、长轴直径(P=6.00E-06)和短轴直径(P=4.77E-04)以及病变的病理亚型(P=3.00E-03)相关。多因素Logistic回归分析显示，每个病灶的通径(P=1.00E-03)、长轴直径(P=3.50E-02)和病理亚型(P=8.00E-03)是分子检测成功的独立危险因素。结论：EBUS-TBNA是一种有效的检测EGFR突变和ALK基因排列的方法，每个病灶至少三次通过，符合常规组织病理学和IHC亚型。使用EBUS-TBNA获得的样本进行成功的病理亚型和分子检测的决定因素是每个病变的通过次数、长轴直径和病理亚型。在EBUS-TBNA过程中，选择较大的淋巴结，每个病灶至少穿刺3次，可获得较高的肺癌亚型和分子检测成功率。
Objective: This study is to explore the determining factors for testing epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) fusion after subtyping by immunohistochemistry (IHC) using samples obtained from endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Materials and Methods: Patients suspected with advanced lung cancer were performed EBUS-TBNA without rapid on-site evaluation(ROSE) from January 2015 to March 2016 in Shanghai Chest Hospital. All samples diagnosed as lung cancer by histopathology underwent IHC to identify subtypes. EGFR mutation and ALK fusion were tested in adenocarcinoma and non-small-cell lung cancer-not otherwise specified (NSCLC-NOS) using remnant tissue samples. Results: A total of 453 patients were diagnosed with lung cancer, including 44.15% (200/453) with adenocarcinoma and 11.04% (50/453) with NSCLC-NOS. With the average passes of 3.41 ± 0.68, samples obtained from EBUS-TBNA were adequate for performing EGFR mutation and ALK fusion gene analysis in 80.4% (201/250) of specimens after routine IHC. On univariate analysis, successful molecular testing was associated with passes per lesion (P = 3.80E-05), long-axis diameters (P = 6.00E-06) and short-axis diameters (P = 4.77E-04), and pathology subtypes of lesions (P = 3.00E-03). Multivariate logistic regression revealed that passes per lesion (P = 1.00E-03), long-axis diameters (P = 3.50E-02), and pathology subtypes (P = 8.00E-03) were independent risk factors associated with successful molecular testing. Conclusions: With at least three passes of per lesion, EBUS-TBNA is an efficient method to provide adequate samples for testing of EGFR mutation and ALK gene arrangement following routine histopathology and IHC subtyping. Determining factors associated with successful pathology subtyping and molecular testing using samples obtained by EBUS-TBNA are passes of per lesion, long-axis diameter, and pathology subtypes. During the process of EBUS-TBNA, selecting larger lymph nodes and the puncturing at least 3 passes per lesion may result in higher success rate in lung cancer subtyping and molecular testing.