Abstract
The diagnostic accuracy of bronchoscopy for detecting lung cancer, especially peripheral lung cancer with lesions outside the endoscopically visible range, remains unsatisfactory. The aim of this study was to perform next-generation sequencing on bronchoscopic specimens to determine whether this improves the accuracy of bronchoscopy for diagnosing lung cancer and to identify factors influencing sensitivity. The bronchoscopic sensitivity for diagnosing lung cancer was initially evaluated in 191 patients who underwent lobectomy after bronchoscopy at our hospital. Sputum, bronchial wash fluid, and resected lung cancer specimens were subsequently collected from 18 patients with peripheral small cell lung cancer for genomic analysis. DNA was extracted from formalin-fixed, paraffin-embedded surgical tissue specimens and the supernatant and cell fractions of sputum and bronchial wash fluid. Deep sequencing was performed using a lung cancer panel covering all exons of 53 lung cancer-related genes. The bronchoscopic sensitivity for diagnosing lung cancer at our hospital was 60.7%. Multivariate analysis revealed that this was influenced by tumor size and location, but not histological type or lymph node metastasis. The sensitivity was the highest for biopsy followed by curettage and bronchial wash specimens. DNA mutations homologous to those identified in the primary lesions were detected in the bronchial wash fluid of 10 patients (55.6%), while only 2 patients (11.1%) were diagnosed with lung cancer based on conventional cytological examinations. In conclusion, the addition of genomic analysis to routine pathological examinations improves the diagnostic accuracy of bronchoscopy.
Highlights
The incidence of central-type squamous cell lung cancer has been decreasing worldwide, whilst that of peripheral lung adenocarcinoma has been increasing
We demonstrate that tumor location and size are important factors for the bronchoscopic diagnosis of lung cancer
The current bronchoscopic diagnostic yield for lung cancer is unsatisfactory, it may be improved by including genetic analyses of bronchoscopic specimens
Summary
The incidence of central-type squamous cell lung cancer has been decreasing worldwide, whilst that of peripheral lung adenocarcinoma has been increasing. A great proportion of lung cancer lesions are outside the endoscopically visible range, making a diagnosis technically challenging [1, 2]. Bronchoscopic examination is an uncomfortable procedure that has limited sensitivity (range, 34.0−88.0%) [2]. Curettage or biopsy forceps are brought in close proximity to the tumor under fluoroscopic guidance. We retrospectively analyzed the patient medical records at our hospital to assess the sensitivity of www.impactjournals.com/oncotarget bronchoscopy for diagnosing lung cancer and to identify factors influencing sensitivity. Curettage, biopsy, and washing are performed, in this order, to make a complete diagnosis. Accurate diagnostic performance was compared between the three specimen types to try to elucidate areas for improvement in bronchoscopic examinations
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