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Background  A specialized classification for small biopsies was added to the 2015 WHO classification of lung tumors. The purpose of this study is to explore and summarize the experience of applying the newly proposed classifications and criteria to clinical practice.    Methods  We used the 2015 WHO criteria to sort out 5032 small lung biopsies from a group of Chinese patients, and demonstrated their clinicopathological features, mutational status and the relationship between these factors.    Results  The most common diagnosis was primary lung carcinoma (3130, 62.2%), among which adenocarcinoma (1421, 28.2%) was the most frequent histological type. The mutational assays using ARMS-PCR technology demonstrated that  EGFR  was positive in 56.1% cases(499/889, from adenocarcinoma and NSCC, favor adenocarcinoma),  ALK  in 5.7% cases(12/211, from NSCC, which comprised all the primary lung carcinomas except small cell carcinomas), and  ROS1  in 0.9% cases(2/211, from NSCC). Another 898 NSCC specimens went through an immunohistochemical (IHC) examination for  ALK  (D5F3) and 38 of them were positive (4.2%). The overall mutation rate of  ALK  was 4.5% (50/1119). There was no significant difference between ARMS-PCR and immunohistochemistry in the positive rate of  ALK  mutation detection ( P  = 0.359).  EGFR  mutations ( P  = 0.02) and  ALK  mutations ( P  < 0.001) both decreased with an increasing patient age. Furthermore, the amount of  EGFR  mutations was higher in adenocarcinoma (64.1% vs 34.1%,  P  < 0.001) than in NSCC, favor adenocarcinoma. In contrast,  ALK  mutations were more common in NSCC, favor adenocarcinoma (4.2% vs 8.4%,  P  = 0.021).    Conclusions  This single-center study exhibited a large subset of small lung biopsies from a Chinese institution and demonstrated that applying the 2015 WHO classification for small lung biopsies can help predict the mutational status of primary lung carcinomas.

Analysis of lung biopsies using the 2015 WHO criteria and detection of sensitizing mutations——a single-institution experience of 5032 cases