title: Comparison of the yield of different diagnostic procedures for cellular differentiation and genetic profiling of non-small-cell lung cancer.
abstract: BACKGROUND
  As treatments for non-small-cell lung cancer (NSCLC) become personalized, cellular and molecular differentiation of the tumor is becoming the standard of care. Our objective is to compare the yield of different diagnostic procedures for cellular differentiation of NSCLC and analysis of epidermal growth factor receptor (EGFR) mutation.
  
  
  METHODS
  We evaluated all patients diagnosed with NSCLC from January 2004 to September 2010 at the Jewish General Hospital, Montreal. Diagnostic procedures included surgical biopsies, nonsurgical histologic biopsies (endobronchial and core needle), transbronchial needle aspirate (TBNA) and transthoracic needle aspirate (TTNA), bronchoalveolar lavage (BAL), and pleural fluid samples.
  
  
  RESULTS
  We included 702 subjects investigated for histopathologic differentiation of NSCLC. Of these, 269 were also investigated for EGFR mutation. Failure to ascertain the cellular subtype and EGFR mutation status was least likely with surgical specimens (0% and 1.8%, respectively); followed by TTNA (14% and 10%, respectively) and histologic biopsy (18% for both); and was frequent with TBNA (39% and 30%, respectively). Although BAL and pleural fluid specimens provided reasonable yield for cellular differentiation (20 % and 11%, respectively), their results were not accurate in 6% of their samples when compared with concurrent or subsequent surgical specimens (reference standard) performed in a subgroup of patients.
  
  
  CONCLUSIONS
  Radiologically guided TTNA and histologic biopsies provided high yield for both molecular and histologic analyses. The yield of unguided TBNA was relatively low. Further studies are needed to assess the adequacy of BAL and pleural fluid samples for EGFR mutation analysis and accurate characterization of cellular subtypes of NSCLC.
authors.affiliation: *Department of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; †Division of Pulmonary Diseases, Department of Internal Medicine; ‡Department of Oncology; and §Department of Pathology, Jewish General Hospital, McGill University, Montreal, Canada.
authors.forename: Amr S
authors.initials: AS
authors.lastname: Albanna
authors.forename: Goulnar
authors.initials: G
authors.lastname: Kasymjanova
authors.forename: Chantal
authors.initials: C
authors.lastname: Robitaille
authors.forename: Victor
authors.initials: V
authors.lastname: Cohen
authors.forename: Guilherme
authors.initials: G
authors.lastname: Brandao
authors.forename: Carmela
authors.initials: C
authors.lastname: Pepe
authors.forename: David
authors.initials: D
authors.lastname: Small
authors.forename: Jason
authors.initials: J
authors.lastname: Agulnik
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000379:methods; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology; D002289:Carcinoma, Non-Small-Cell Lung / Q000235:genetics* / Q000473:pathology* / Q000601:surgery; D002454:Cell Differentiation; D066246:ErbB Receptors / Q000235:genetics*; D005260:Female; D020869:Gene Expression Profiling; D006801:Humans; D061705:Image-Guided Biopsy; D008168:Lung / Q000473:pathology*; D008175:Lung Neoplasms / Q000235:genetics* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009154:Mutation; D010996:Pleural Effusion / Q000473:pathology
chemical_list: D066246:ErbB Receptors