Elsevier

Lung Cancer

Volume 67, Issue 2, February 2010, Pages 166-169
Lung Cancer

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

https://doi.org/10.1016/j.lungcan.2009.04.007Get rights and content

Abstract

Introduction

To compare adequacy of tissue acquisition for EGFR DNA mutation analysis and the resulting complications in CT-guided lung biopsy cases with either 18-gauge or 20-gauge core biopsy needle.

Methods

Forty-seven patients with advanced staged non-small cell lung cancers who were failure-treated by conventional chemotherapy were retrospectively reviewed. All had received CT-guided core needle lung biopsy for histology diagnosis and freshly frozen for EGFR mutation analysis before targeted therapy. We compared the complications resulting from these CT-guided lung biopsies and the specimen assessment using 18-gauge (32 patients) or 20-gauge (15 patients) biopsy needle via 17-gauge or 19-gauge coaxial needle.

Results

With an overall pneumothorax rate of 12.8%, pneumothorax occurred in 12.5% and 13.3% of patients by 17-gauge and 19-gauge coaxial needles respectively. The overall rate of hemoptysis was 6.4%, with 6.3% by 18-gauge biopsy needle and 6.6% by 20-gauge biopsy needle. Large peritumoral hemorrhage revealed only in 2 cases of those completed with 18-gauge biopsy needles. 18-gauge biopsy needle obtained larger specimens with heavier weight (average 10.15 mg vs 9 mg) and higher DNA concentration (average 47.13 ng/ul vs 35.92 ng/ul) than 20-gauge biopsy needle. Otherwise, the range of optical density (1.67–2.09) was more constant in the specimens by 20-gauge biopsy needles. Mutation demonstration was achieved for all samples.

Conclusion

CT-guided core needle biopsy is a feasible technique in acquisition of fresh cancer tissues for EGFR gene mutation analysis. The specimen is adequate for gene demonstration either using 18-gauge or 20-gauge tru-cut biopsy needles via 17-gauge or 19-gauge coaxial needles.

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.

Section snippets

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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