Adequacy and complications of computed tomography-guided core needle biopsy on non-small cell lung cancers for epidermal growth factor receptor mutations demonstration: 18-gauge or 20-gauge biopsy needle
Introduction
Computed tomography (CT) guided that needle biopsy is a minimally invasive procedure promising the accurate performance of obtaining specimens from lung masses for diagnosis. Diagnostically, needle biopsy of lung lesions has become the mainstay for non-surgical procurement of tissues with concordance rate up to 80% [1] indicating high reliability of such biopsy specimens [2]. Recent advances in understanding of tumor biology and molecular pathways lead the development of targeted therapy on lung cancer with identification of epidermal growth factor receptor (EGFR) inhibitors. This targeted therapy using tyrosine kinase inhibitor, such as gefitinib, had shown higher clinical response rates in the subgroup of patients with female gender, non-smoker, adenocarcinoma histology and East Asian origin [3]. The demonstration of such activating mutations in the tyrosine kinase domain of EGFR from tumor tissues had been proved responsive in tumor shrinkage with EGFR inhibitor therapy [4], [5], a type of supportive treatment selection based on molecular classification.
Surgical interventions that are used to obtain specimens for DNA analysis are more invasive with higher morbidity and possibly mortality when compared to minimally invasive CT-guided core needle biopsy. Several reports had published the usefulness of needle biopsy specimens for mutation demonstration of lung cancers [6], [7], [8], [9], especially for the advanced or inoperable lung cancer types. This percutanous minimally invasive procedure provides evidence-based mutation demonstration which can be used to further dictate therapy. In order to meet the challenges of molecular analysis, the size of biopsy needle used to obtain adequate sample for mutation analysis and the complication of CT-guided biopsy have become the important considerable factors for the biopsy procedure. We compared the complications resulting from CT-guided lung biopsy and the obtained tissue data for EGFR mutations demonstration using 18-gauge and 20-gauge biopsy needles.
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Patients selection
The records of 47 patients with non-small cell lung cancers who were failure the treatment of conventional chemotherapy from August 2005 to December 2007 were retrospectively reviewed. Before starting the targeted therapy (gefitinib therapy), they all had received CT-guided core needle biopsy to obtain fresh-frozen tissue for EGFR demonstration All the lung cancers located at peripheral region of lung (more than 2 cm away from pulmonary hilum) on the CT images. After full explanation and
Results
There were 24 male and 23 female patients enrolled in this study. The average age was 64.6 years (ranging from 42 y/o to 90 y/o) and the greatest diameter of the lung masses was measured to be an average of 4.07 cm (ranging from 2 cm to 10 cm) on computed tomogram. Histological examination of the needle biopsies diagnosed 36 (76.6%) adenocarcinoma, 6 (12.8%) adenocarcinoma with bronchioloalveolar pattern and 5 (10.6%) squamous cell carcinoma comparison of 18-gauge (32 patients) and 20-gauge (15
Discussion
Lung cancer, especially non-small cell lung cancer (NSCLC), is the leading cause of death in many countries [10]. Nearly 70% of NSCLC patients present with advanced or unresectable tumor at the time of discovery [3]. In such cases of lung cancers, chemotherapy is the mainstream therapy with most benefits and best supportive care [11]. Unfortunately, the therapeutic response of conventional chemotherapy is unevenly limited with 17–22% response rates with median survival of 7–8 months; even when
Conflict of interest
All the authors disclose any financial and personal relationships with other people or organisations that could inappropriately influence (bias) their work.
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