Repeat Biopsy for Mutational Analysis of Non–Small Cell Lung Cancers Resistant to Previous Chemotherapy: Adequacy and Complications

Abstract

To evaluate the feasibility and safety of repeat biopsy for mutational analysis in patients with non-small cell lung cancer (NSCLC) who have a resistance history to previous chemotherapy. This prospective study was institutional review board approved, and written informed consent was obtained from all patients. Of 126 patients referred for repeat biopsy (hereafter, rebiopsy) with NSCLC that was resistant to conventional chemotherapy or epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors, 94 patients (31 men, 63 women; mean age ± standard deviation, 57 years ± 10.3) were selected for rebiopsy. Thirty-two patients were excluded for several reasons after strict review of the chest computed tomography (CT) images. Percutaneous transthoracic lung biopsy was performed with C-arm cone-beam CT guidance. The technical success rates for the rebiopsy and the adequacy rates of specimens for mutational analysis were evaluated. Any biopsy-related complications were recorded. The technical success rate for biopsy was 100%. In 75 (80%) of 94 patients, specimens were adequate for mutational analysis. Of 75 specimens, 35 were tested for EGFR mutation, 34 for anaplastic lymphoma kinase gene (ALK) rearrangement, and six for both. The results were positive for EGFR-sensitizing mutation (exon 19 or 21) in 20, for EGFR T790M mutation in five, and for ALK rearrangement in 11. Postprocedural complications occurred in 13 (14%) of 94 patients. When performed by employing rigorous CT criteria, rebiopsies for the mutational analysis of NSCLCs treated previously with chemotherapy are feasible in all patients and are adequate in approximately four-fifths of patients referred for gene analysis, with acceptable rates of complications.