Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2020; 8(21): 5139-5148
Published online Nov 6, 2020. doi: 10.12998/wjcc.v8.i21.5139
Accuracy of endoscopic ultrasound-guided needle aspiration specimens for molecular diagnosis of non-small-cell lung carcinoma
Wei Su, Xiang-Dong Tian, Peng Liu, De-Jun Zhou, Fu-Liang Cao
Wei Su, Xiang-Dong Tian, Peng Liu, De-Jun Zhou, Fu-Liang Cao, Department of Endoscopy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
Author contributions: Su W collected and analyzed the data and wrote the paper; Tian XD collected medical record information and searched references; Liu P provided clinical advice and modified the manuscript; Zhou DJ designed the research and supervised the report; Cao FL designed the research and approved final version of paper; All authors have read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 81903055; and Tumor Translational Medicine Seed Fund of Tianjin Medical University Cancer Institute and Hospital, No. 1709.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Tianjin Medical University Cancer Institute and Hospital (Approval No. bc2020023).
Informed consent statement: Patients were not required to provide informed consent for this study because the analysis used anonymous clinical data that were obtained after patient had agreed to treatment with written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fu-Liang Cao, MD, Attending Doctor, Department of Endoscopy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, West Huanhu Road, Ti Yuan Bei, Hexi District, Tianjin 300060, China. fuliangcao2008@163.com
Received: June 28, 2020
Peer-review started: June 28, 2020
First decision: July 24, 2020
Revised: August 4, 2020
Accepted: September 25, 2020
Article in press: September 25, 2020
Published online: November 6, 2020
Processing time: 131 Days and 0.1 Hours
Abstract
BACKGROUND

Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) are highly sensitive for diagnosing and staging lung cancer. In recent years, targeted therapy has shown great significance in the treatment of non-small cell lung carcinoma (NSCLC). Using these minimally invasive techniques to obtain specimens for molecular testing will provide patients with a more convenient diagnostic approach.

AIM

To evaluate the feasibility and accuracy of tissue samples obtained using EUS-FNA and EBUS-TBNA for molecular diagnosis of NSCLC.

METHODS

A total of 83 patients with NSCLC underwent molecular testing using tissues obtained from EUS-FNA or EBUS-TBNA at the Tianjin Medical University Cancer Hospital from January 2017 to June 2019. All enrolled patients underwent chest computed tomography or positron emission tomography/computed tomography prior to puncture. We detected abnormal expression of EGFR, KRAS, MET, HER2, ROS1 and anaplastic lymphoma kinase protein. Two patients failed to complete molecular testing due to insufficient tumor tissue. The clinical features, puncture records, molecular testing results and targeted treatment in the remaining 81 patients were summarized.

RESULTS

In a total of 99 tissue samples obtained from 83 patients, molecular testing was successfully completed in 93 samples with a sample adequacy ratio of 93.9% (93/99). Biopsy samples from two patients failed to provide test results due to insufficient tumor tissue. In the remaining 81 patients, 62 cases (76.5%) were found to have adenocarcinoma, 11 cases (13.6%) had squamous cell carcinoma, 3 cases (3.7%) had adenosquamous carcinoma and 5 cases (6.2%) had NSCLC-not otherwise specified. The results of molecular testing showed EGFR mutations in 21 cases (25.9%), KRAS mutations in 9 cases (11.1%), ROS-1 rearrangement in 1 case (1.2%) and anaplastic lymphoma kinase-positive in 5 cases (6.2%). Twenty-four patients with positive results received targeted therapy. The total effectiveness rate of targeted therapy was 66.7% (16/24), and the disease control rate was 83.3% (20/24).

CONCLUSION

Tissue samples obtained by EUS-FNA or EBUS-TBNA are feasible for the molecular diagnosis of NSCLC and can provide reliable evidence for clinical diagnosis and treatment.

Keywords: Endobronchial ultrasound-guided transbronchial needle aspiration; Endoscopic ultrasonography-guided fine-needle aspiration; Non-small cell lung carcinoma; Molecular diagnosis; Targeted therapy

Core Tip: The purpose of this retrospective study was to evaluate the feasibility and reliability of tissue samples obtained using endoscopic ultrasonography-guided fine-needle aspiration and endobronchial ultrasound-guided transbronchial needle aspiration for molecular diagnosis of non-small cell lung carcinoma. In the study, 93.9% of the puncture samples could be used for molecular testing. The proportion of patients with positive results corresponds to the frequency of molecular mutations. Patients receiving targeted therapy responded well to treatment. The samples obtained by the two techniques can be used for molecular diagnosis of lung cancer. They can provide reliable evidence for clinical diagnosis and treatment.