title: Suitability of computed tomography-guided biopsy specimens for subtyping and genotyping of non-small-cell lung cancer.
abstract: BACKGROUND
  Recent advances in the treatment of NSCLC highlight the importance of distinguishing NSCLC subtypes and genotypes. We aimed to determine whether histological specimens obtained from computed tomography (CT)-guided biopsy are suitable for specific subtyping and epidermal growth factor receptor (EGFR) analyses of NSCLC.
  
  
  METHODS
  The clinicohistological data of 332 consecutive patients undergoing 352 CT-guided biopsies for lung lesions between January 2007 and December 2011 were retrospectively analyzed. Additionally, NSCLC specimens were examined for the suitability of EGFR mutational testing.
  
  
  RESULTS
  Of 209 specimens diagnosed as NSCLC, 197 (94.3%) were specifically subtyped into adenocarcinoma (n = 164; 78.5%), squamous cell carcinoma (n = 27; 12.9%) and other subtypes (n = 6; 2.9%). The rate of NSCLC not otherwise specified (NOS) was 5.7%, and the diagnosis of NSCLC-NOS was significantly associated with the poor differentiation of cancer (adjusted odds ratio, 6.17; 95% confidence interval, 1.62-23.55; P = .008). Of 134 histological tumor specimens submitted for EGFR molecular testing, 132 (98.5%) were suitable for analyses, and 130 of them (98.5%) showed conclusive results, revealing 59.8% (n = 79) with EGFR exon mutation(s). The sensitivity, specificity, and positive and negative predictive values of CT-guided biopsy in patients with malignancy were 92.2%, 100%, 100%, and 74.1%, respectively. Six percent (n = 21) of total lung biopsies led to pneumothorax requiring chest drainage, and no procedure-related fatality was observed.
  
  
  CONCLUSIONS
  Small tumor specimens obtained with CT-guided needle lung biopsy are suitable for specific subtyping and EGFR analyses of NSCLC, thus providing critical information for personalized therapy.
authors.affiliation: Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
authors.forename: Shih-Hsin
authors.initials: SH
authors.lastname: Hsiao
authors.forename: Chi-Li
authors.initials: CL
authors.lastname: Chung
authors.forename: Chi-Ming
authors.initials: CM
authors.lastname: Lee
authors.forename: Wei-Yu
authors.initials: WY
authors.lastname: Chen
authors.forename: Yu-Ting
authors.initials: YT
authors.lastname: Chou
authors.forename: Zhung-Han
authors.initials: ZH
authors.lastname: Wu
authors.forename: Yi-Chie
authors.initials: YC
authors.lastname: Chen
authors.forename: Sey-En
authors.initials: SE
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D063646:Carcinogenesis; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D004252:DNA Mutational Analysis; D005240:Feasibility Studies; D005260:Female; D018773:Genes, erbB-1 / Q000235:genetics*; D005838:Genotype; D006801:Humans; D061705:Image-Guided Biopsy; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013048:Specimen Handling / Q000379:methods; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Epidermal growth factor receptor mutations; Genotyping; Non-small cell lung cancer; Subtyping