Abstract
BackgroundRecent publications have emphasized the importance of a multidisciplinary strategy for maximum conservation and utilization of lung biopsy material for advanced testing, which may determine therapy. This paper quantifies the effect of a multidisciplinary strategy implemented to optimize and increase tissue volume in CT-guided transthoracic needle core lung biopsies. The strategy was three-pronged: (1) once there was confidence diagnostic tissue had been obtained and if safe for the patient, additional biopsy passes were performed to further increase volume of biopsy material, (2) biopsy material was placed in multiple cassettes for processing, and (3) all tissue ribbons were conserved when cutting blocks in the histology laboratory. This study quantifies the effects of strategies #1 and #2.DesignThis retrospective analysis comparing CT-guided lung biopsies from 2007 and 2012 (before and after multidisciplinary approach implementation) was performed at a single institution. Patient medical records were reviewed and main variables analyzed include biopsy sample size, radiologist, number of blocks submitted, diagnosis, and complications. The biopsy sample size measured was considered to be directly proportional to tissue volume in the block.ResultsBiopsy sample size increased 2.5 fold with the average total biopsy sample size increasing from 1.0 cm (0.9–1.1 cm) in 2007 to 2.5 cm (2.3–2.8 cm) in 2012 (P<0.0001). The improvement was statistically significant for each individual radiologist. During the same time, the rate of pneumothorax requiring chest tube placement decreased from 15% to 7% (P = 0.065). No other major complications were identified. The proportion of tumor within the biopsy material was similar at 28% (23%–33%) and 35% (30%–40%) for 2007 and 2012, respectively. The number of cases with at least two blocks available for testing increased from 10.7% to 96.4% (P<0.0001).ConclusionsThe effect of this multidisciplinary strategy to CT-guided lung biopsies was effective in significantly increasing tissue volume and number of blocks available for advanced diagnostic testing.
Highlights
BackgroundLung cancer is the most common cancer and leading cause of cancer death in the United States with an estimated 224,000 new cases and 159,000 deaths in 2014. [1,2,3] Historically, tumors have been divided into small cell carcinoma (15%) and non-small cell carcinoma/other subtypes (85%) for treatment purposes. [4] Recent advances in treatment of non-small cell carcinomas, including bevacizumab, premetrexed, erlotinib, and crizotinib, have brought hope for prolonged survival and quality of life in advance stage disease. [5]These recent advances have required pathologists to accurately sub-classify non-small cell carcinomas and conserve tissue for molecular/advanced testing
The strategy was three-pronged: (1) once there was confidence diagnostic tissue had been obtained and if safe for the patient, additional biopsy passes were performed to further increase volume of biopsy material, (2) biopsy material was placed in multiple cassettes for processing, and (3) all tissue ribbons were conserved when cutting blocks in the histology laboratory
The improvement was statistically significant for each individual radiologist
Summary
BackgroundLung cancer is the most common cancer and leading cause of cancer death in the United States with an estimated 224,000 new cases and 159,000 deaths in 2014. [1,2,3] Historically, tumors have been divided into small cell carcinoma (15%) and non-small cell carcinoma/other subtypes (85%) for treatment purposes. [4] Recent advances in treatment of non-small cell carcinomas, including bevacizumab, premetrexed, erlotinib, and crizotinib, have brought hope for prolonged survival and quality of life in advance stage disease. [5]These recent advances have required pathologists to accurately sub-classify non-small cell carcinomas and conserve tissue for molecular/advanced testing. [7] ALK and ROS-1 mutated tumors (typically adenocarcinomas or large cell carcinomas) have high response rates (61–72%) and prolonged survival when treated with crizotinib. [5, 12,13,14] The 2011 the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society (ATS/ERS/IASLC) classification review was one of the first prominent publications to emphasize a multidisciplinary approach, but to our knowledge there is no documentation in the medical literature quantifying the effect of a multidisciplinary strategy to increase the volume of diagnostic tissue for molecular/advanced testing. Recent publications have emphasized the importance of a multidisciplinary strategy for maximum conservation and utilization of lung biopsy material for advanced testing, which may determine therapy. This study quantifies the effects of strategies #1 and #2
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