Molecular analysis of peripheral non‐squamous non‐small cell lung cancer sampled by radial EBUS. Issue 4 (27th January 2016)

• Record Type: Journal Article
• Authors: Guisier, Florian; Salaün, Mathieu; Lachkar, Samy; Lamy, Aude; Piton, Nicolas; Obstoy, Bérengère; Sabourin, Jean‐Christophe; Thiberville, Luc
• Is Part Of: Respirology. Volume 21:Issue 4(2016)
• Page Start: 718
• Page End: 726
• Publication Date: 2016-01-27
• Subjects: lung adenocarcinoma -- molecular analysis -- navigational bronchoscopy -- peripheral lung nodule -- radial endobronchial‐ultrasound bronchoscopy; Respiratory organs -- Diseases -- Periodicals; Respiratory organs -- Periodicals; 612.2
• DOI: 10.1111/resp.12737
• Languages: English
• ISSNs: 1323-7799

Abstract

Abstract: Background and objective: Treatment optimization of non‐squamous non‐small‐cell lung cancers (nonSq‐NSCLC) relies on the molecular analysis of the tumour. We aimed to assess the predictive factors of molecular analysis feasibility (MAF) from samples of peripheral nonSq‐NSCLC obtained by radial endobronchial ultrasound bronchoscopy (r‐EBUS) and 1.5 mm microbiopsy forceps. Methods: We reviewed data from consecutive peripheral lung nodules sampled with r‐EBUS between January 2012 and July 2014 at a single French University Hospital. nonSq‐NSCLC were systematically analysed for EGFR, KRAS, ALK, HER 2, PI3K and BRAF throughout the study, and c‐ MET and ROS 1 alterations for the last 10 months. Results: Of 111 nonSq‐NSCLC diagnosed by r‐EBUS (113 procedures, mean nodule diameter 28 ± 15 mm), 88 were analysed for EGFR and ALK, 87 for KRAS, 86 for HER 2, PI3K and BRAF and 14 for c‐ MET . Forty‐one mutations were identified (23 KRAS, 10 EGFR, 2 BRAF, 1 HER 2 and 5 ALK rearrangements). Four c‐ MET overexpressions were noted. MAF rose from 67% for the first 57 procedures to 89% for the last 56 procedures ( P = 0.02) likely due to a higher number of biopsies performed (2 ± 1 vs 3 ± 2, P = 0.005). Upper or middle lobe location (OR 1.19, 95% CI: 1.02–1.38, P = 0.03), and at least three biopsies (OR 1.20, 95% CI: 1.04–1.40, P = 0.02) were predictive factors of MAF. Percentage of tumour cells, size of lesion and distance to the pleura did not correlate with MAF. Conclusion: Multi‐gene molecular analysis could be performed in nearly 80% of paraffin‐embedded biopsies or smear specimens sampled by r‐EBUS assisted bronchoscopy of peripheral tumoral lung nodules. Abstract : The optimal treatment of non‐squamous non‐small cell lung cancer currently needs the realization of molecular analysis from the initial diagnostic biopsy sampling. This study shows that multi‐gene analysis (EGFR, ALK, HER2, BRAF) is feasible in 80% of routine radial‐EBUS assisted bronchoscopy sampling of peripheral lung nodules.