Adequacy of core needle biopsy specimens and fine-needle aspirates for molecular testing of lung adenocarcinomas.
Author(s): Schneider F, Smith MA, Lane MC, Pantanowitz L, Dacic S, Ohori NP
Publication: Am J Clin Pathol, 2015, Vol. 143, Page 193-200; quiz 306
PubMed ID: 25596245 PubMed Review Paper? No
Purpose of Paper
The purpose of this paper was to determine the effects of tissue acquisition method, tumor size, and operator and pathologist experience on the successful molecular analysis of epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK) and kirsten rat sarcoma viral oncogene homolog (KRAS) in formalin-fixed paraffin-embedded (FFPE) lung adenocarcinoma specimens.
Conclusion of Paper
While 67% (35/52) of core-needle biopsy (CNB) specimens allowed for determination of EGFR and KRAS mutation and ALK translocation status, EGFR and KRAS mutation and ALK translocation status were only determined in 46% (55/120) of fine needle aspirate (FNA) specimens. Most failures of FNA specimens were due to pathologists determination of insufficient tumor content, but this was rarely found for CNB. FNA success was associated with tumor size and operator, but not significantly affected by pathologist a number of FNA passes.
Studies
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Study Purpose
The purpose of this study was to determine the effects of tissue acquisition method, tumor size, and operator and pathologist experience on the successful molecular analysis of EGFR, ALK and KRAS in FFPE lung adenocarcinoma specimens. The study included a total of 52 CT guided CNB obtained using an 18 to 22 gauge syringe and 120 CT guided FNA specimens obtained using 22 to 25 gauge needles of lung adenocarcinoma. Tumor content was determined by hematoxylin and eosin (H&E) staining.
Summary of Findings:
While 67% (35/52) of CNB specimens allowed for determination of EGFR and KRAS mutation and ALK translocation status, EGFR and KRAS mutation and ALK translocation status were only determined in 46% (55/120) of FNA specimens (p=0.007). 52% (62/120) of FNA specimens, but only 4% (2/52) CNB were determined by the pathologist to have insufficient tumor content for analysis. Importantly, the authors report that obtaining sufficient material from the FNA but not CNB was positively associated with tumor size (p=0.015 and p>0.05, respectively). When two FNA needle passes were conducted instead of one the success rate increased non-significantly from 45% to 48%. Further, a positive effect of 1 of the 11 FNA operators was identified (p=0.017), but there was no effect of pathologist or between the other 10 FNA operators.
Biospecimens
Preservative Types
- Formalin
Diagnoses:
- Neoplastic - Carcinoma
Platform:
Analyte Technology Platform DNA DNA sequencing Morphology H-and-E microscopy DNA FISH Pre-analytical Factors:
Classification Pre-analytical Factor Value(s) DNA sequencing Specific Targeted nucleic acid KRAS
EGFR
FISH Specific Targeted nucleic acid ALK
Biospecimen Acquisition Method of tissue acquisition Staff performing tissue acquisition compared
Core needle biopsy
Fine needle aspiration
FISH Specific Data handling Pathologists compared
Biospecimen Aliquots and Components Aliquot size/volume 1 FNA pass
2 FNA passes