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Molecular analysis of peripheral non‐squamous non‐small cell lung cancer sampled by radial EBUS
Author(s) -
Guisier Florian,
Salaün Mathieu,
Lachkar Samy,
Lamy Aude,
Piton Nicolas,
Obstoy Bérengère,
Sabourin JeanChristophe,
Thiberville Luc
Publication year - 2016
Publication title -
respirology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.857
H-Index - 85
eISSN - 1440-1843
pISSN - 1323-7799
DOI - 10.1111/resp.12737
Subject(s) - medicine , kras , lung cancer , bronchoscopy , lung , afatinib , adenocarcinoma , nodule (geology) , biopsy , pathology , cancer , colorectal cancer , radiology , epidermal growth factor receptor , erlotinib , biology , paleontology
Background and objective Treatment optimization of non‐squamous non‐small‐cell lung cancers ( nonS q‐ 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 nonS q‐ 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 J anuary 2012 and J uly 2014 at a single F rench U niversity H ospital. nonS q‐ 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.