Abstract
105 Background: The National Comprehensive Cancer Network recommends that all patients with lung adenocarcinoma (LA) be tested for EGFR mutation and ALK gene rearrangement (EGFR/ALK). Metastatic LA is diagnosed with biopsies often sufficient only for non-molecular based diagnostic techniques; our institutional experience suggested conventionally obtained material was inadequate for EGFR/ALK. We analyzed biopsies performed only with the intent of diagnosing malignancy for adequacy for EGFR/ALK. Methods: We identified patients from LSU diagnosed with metastatic LA whose specimens were sent for EGFR/ALK from January 1, 2009, to June 30, 2013. Data collected included number of specimens sent for EGFR/ALK, number of samples with inadequate tumor, biopsy technique utilized and number of rebiopsy attempts for EGFR/ALK. Results: 54 patients were evaluated in the study time period: 58 individual biopsy specimens were sent for EGFR/ALK. 24/58 (41%) of specimens were found to be inadequate for EGFR/ALK. 11/26 (42%) of bronchoscopically obtained biopsies were inadequate, 9/18 (50%) of computed tomography guided core needle (CTGCN) biopsies were inadequate and 4/14 (28%) samples obtained via thoracentesis, wedge resection, craniotomy, spinal tumor excision, fine needle aspiration of lymph nodes or video assisted thoracoscopic surgery were inadequate. 4/54 (7%) patients underwent rebiopsy, 3 via bronchoscopy and 1 via CTGCN; 3/4 (75%) rebiopsies were sufficient for EGFR/ALK analysis. Conclusions: A substantial proportion of initial LA diagnostic biopsies were inadequate for EGFR/ALK analysis. While EGFR/ALK analysis is now standard of care for patients with LA, only a small percentage of patients in our study underwent rebiopsy. Our institutional practice will be modified to encourage additional biopsies for the specific purpose of molecular testing at the time of initial biopsy for those with suspected LA.
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