Abstract
BackgroundPatients treated for non-squamous (non-Sq) non-small cell lung cancer (NSCLC) often require repeat biopsies to determine the optimal subsequent treatment. However, the differences between rebiopsy and initial biopsy in terms of their diagnostic yields and their ability to test the molecular profiles using bronchoscopy with radial endobronchial ultrasound guidance in patients with advanced NSCLC remain unclear. Hence, we aimed to compare the diagnostic yields and ability for molecular analyses of rebiopsies with those of initial biopsies.MethodsWe investigated 301 patients with advanced non-Sq NSCLC who underwent radial endobronchial ultrasound-guided transbronchial biopsy (TBB) for peripheral pulmonary lesions (PPLs) between August 2014 and July 2017. Patients were divided into the rebiopsy and initial biopsy groups: the latter referred to the biopsy that determined the definitive diagnosis. The diagnostic yields and ability for molecular analyses were compared between the two groups, and the factors affecting the TBB diagnostic yield were identified using univariate and multivariate analyses.ResultsThe diagnostic yields of the rebiopsy and initial biopsy groups were comparable (86.8 and 90.8%, respectively; p = 0.287). Furthermore, 93.0 and 94.0% of the patients in the rebiopsy and initial biopsy groups, respectively, had adequate specimens for gene profiling and mutational analysis (p = 0.765). The factors that increased the diagnostic yield were a positive bronchus sign (p < 0.001) and tumour location within the internal two-thirds of the lungs (p = 0.026).ConclusionsThe PPL diagnostic yield of the rebiopsy group was as high as that of the initial biopsy group. Hence, TBB for PPLs is feasible for patients requiring rebiopsy as well as for those with initial diagnoses. Adequate, high-quality biopsy specimens can be obtained by transbronchial rebiopsy for molecular testing.
Highlights
Patients treated for non-squamous non-small cell lung cancer (NSCLC) often require repeat biopsies to determine the optimal subsequent treatment
Targeted therapies directed at tumour cells harbouring epidermal growth factor receptor (EGFR) gene mutations, anaplastic lymphoma kinase (ALK) gene rearrangements, ROS proto-oncogene 1 (ROS1) gene fusions, and B-Raf protooncogene (BRAF) gene mutations have produced impressive results [6,7,8,9]
This study aimed to compare the diagnostic yields obtained from rebiopsy to those obtained from initial biopsy and their ability to test the molecular profiles by means of bronchoscopy with radial endobronchial ultrasound (R-EBUS) guidance
Summary
Patients treated for non-squamous (non-Sq) non-small cell lung cancer (NSCLC) often require repeat biopsies to determine the optimal subsequent treatment. The differences between rebiopsy and initial biopsy in terms of their diagnostic yields and their ability to test the molecular profiles using bronchoscopy with radial endobronchial ultrasound guidance in patients with advanced NSCLC remain unclear. We aimed to compare the diagnostic yields and ability for molecular analyses of rebiopsies with those of initial biopsies. Lung cancer is the leading cause of mortality worldwide [1, 2]. Cytotoxic chemotherapies such as platinum-based regimens have been the primary therapeutic option for advanced non-small cell lung cancer (NSCLC) [3]. A rebiopsy is required for detecting the T790M mutation in such patients [11, 13]
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