title: Histologic and molecular characterization of lung cancer with tissue obtained by electromagnetic navigation bronchoscopy.
abstract: BACKGROUND
  Electromagnetic navigation bronchoscopy (ENB) is a catheter-based adjunct to standard bronchoscopic techniques for the sampling of lung lesions. We sought to evaluate the adequacy of ENB-obtained samples for histologic subtyping of lung cancer, epidermal growth factor receptor (EGFR) mutations, and echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase (EML4-ALK) translocations.
  
  
  METHODS
  We retrospectively analyzed consecutive patients who underwent ENB for the diagnosis of lung lesions between 2008 and 2011. In those proven to be a primary lung cancer by ENB, tissue adequacy for histologic subtyping was recorded. Accuracy was determined by comparison with resected specimens when available. Tissue adequacy for EGFR mutation and/or EML4-ALK analyses was also reviewed.
  
  
  RESULTS
  Sixty-five ENB cases resulted in a diagnosis of lung cancer. Tissues obtained were adequate for histologic subtyping in all 65 cases. Forty-three (66.2%) were diagnosed with adenocarcinoma, 19 (29.2%) with squamous cell carcinoma, 3 (4.6%) with small cell carcinoma. In 51 cases (78.5%), subtyping was performed by morphology alone, whereas 11 (21.5%) required immunohistochemical staining. Sixteen of 65 tumors underwent surgical resection. Concordance of histologic subtyping between ENB and surgical specimens was 87.5% (14 tumors). ENB-obtained samples from 15 patients with adenocarcinoma were sent for EGFR mutation analysis, of which 14 (93.3%) were adequate. Samples from 2 patients were evaluated for EML4-ALK gene rearrangements, both of which were adequate for analysis.
  
  
  CONCLUSIONS
  ENB is effective at obtaining tissue samples adequate for histologic subtyping, EGFR mutation, and EML4-ALK translocation analysis.
authors: Department of Internal Medicine Respiratory Institute ‡Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH 44195, USA. had@ccf.org
authors: Duc
authors: D
authors: Ha
authors: Humberto
authors: H
authors: Choi
authors: Francisco A
authors: FA
authors: Almeida
authors: Andrea
authors: A
authors: Arrossi
authors: Jennifer
authors: J
authors: Brainard
authors: Joseph
authors: J
authors: Cicenia
authors: Carol
authors: C
authors: Farver
authors: Thomas
authors: T
authors: Gildea
authors: Michael S
authors: MS
authors: Machuzak
authors: Peter
authors: P
authors: Mazzone
mesh_terms: D000230:Adenocarcinoma / Q000235:genetics / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000077548:Anaplastic Lymphoma Kinase; D001999:Bronchoscopy / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000235:genetics / Q000473:pathology*; D055590:Electromagnetic Phenomena; D066246:ErbB Receptors / Q000235:genetics; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000235:genetics / Q000473:pathology*; D008297:Male; D008869:Microtubule-Associated Proteins / Q000235:genetics; D008875:Middle Aged; D020794:Receptor Protein-Tyrosine Kinases / Q000235:genetics; D012189:Retrospective Studies; D055752:Small Cell Lung Carcinoma / Q000235:genetics / Q000473:pathology*; D014178:Translocation, Genetic
chemical_list: D008869:Microtubule-Associated Proteins; C000626173:ALK protein, human; D000077548:Anaplastic Lymphoma Kinase; D066246:ErbB Receptors; D020794:Receptor Protein-Tyrosine Kinases