Anaplastic lymphoma kinase gene rearrangements in cytological samples of non–small cell lung cancer: Comparison with histological assessment. Issue 6 (19th March 2014)

• Record Type: Journal Article
• Authors: Proietti, Agnese; Alì, Greta; Pelliccioni, Serena; Lupi, Cristiana; Sensi, Elisa; Boldrini, Laura; Servadio, Adele; Chella, Antonio; Ribechini, Alessandro; Cappuzzo, Federico; Miccoli, Mario; Fontanini, Gabriella
• Is Part Of: Cancer cytopathology. Volume 122:Issue 6(2014:Jun.)
• Page Start: 445
• Page End: 453
• Publication Date: 2014-03-19
• Subjects: Cancer -- Cytopathology -- Periodicals; Pathology, Cellular -- Periodicals; Cytology -- Technique -- Periodicals; 611.01815
• DOI: 10.1002/cncy.21418
• Languages: English
• ISSNs: 1934-662X

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="cncy21418-sec-0001" sec-type="section"> <title>BACKGROUND</title> <p>Anaplastic lymphoma kinase (<italic>ALK</italic>) gene rearrangements are detected in approximately 5% of cases of non‐small cell lung cancer (NSCLC). Patients who are positive for <italic>ALK</italic> rearrangements may be successfully treated with the <italic>ALK</italic> inhibitor crizotinib. Because advanced‐stage lung cancers are not suitable for surgical resection, approximately 70% of patients are diagnosed via preoperative specimens. In the current study, the authors evaluated the suitability of stained cytologic direct smears and cell blocks for fluorescence in situ hybridization (FISH) to determine <italic>ALK</italic> status compared with small biopsies.</p> </sec> <sec id="cncy21418-sec-0002" sec-type="section"> <title>METHODS</title> <p>A total of 493 consecutive patients with NSCLC were analyzed by FISH for <italic>ALK</italic> gene rearrangements. The analyzed sample comprised 180 cytological samples, 94 direct smears, 86 cell blocks, and 313 preoperative small biopsies. Moreover, in the same series, 426 patients and 369 patients, respectively, were evaluated for epidermal growth factor receptor and <italic>KRAS</italic> mutations, respectively.</p> </sec> <sec id="cncy21418-sec-0003" sec-type="section"> <title>RESULTS</title> <p>Of the total of 493 patients, 18 patients who were positive for a gene rearrangement (4.4%) demonstrated <italic>ALK</italic> FISH rearrangements, whereas 387 patients (95.6%) were negative. All other cases were classified as inadequate (7.7%) and insufficient (10.1%). A strong statistical association was found between the cytology and the small biopsy with respect to <italic>ALK</italic> rearrangements (<italic>P</italic> = .0048). Fifty‐three patients (12.4%) demonstrated an epidermal growth factor receptor mutation, whereas 90 patients (24.4%) were found to have <italic>KRAS</italic> mutations. None of these patients presented with <italic>ALK</italic> gene rearrangements.</p> </sec> <sec id="cncy21418-sec-0004" sec-type="section"> <title>CONCLUSIONS</title> <p> <italic>ALK</italic> gene rearrangements may be easily detected in cytological samples and particularly in direct smears, thereby yielding important improvements in the diagnostic approach to patients with advanced NSCLC. Cytological samples may be useful for <italic>ALK</italic> analysis when insufficient material is available in cell blocks or small biopsies. <bold><italic>Cancer (Cancer Cytopathol)</italic> 2014;122:445–453</bold>. © <italic>2014 American Cancer Society</italic>.</p> </sec> </abstract>