title: FNA, core biopsy, or both for the diagnosis of lung carcinoma: Obtaining sufficient tissue for a specific diagnosis and molecular testing.
abstract: BACKGROUND
  Increasingly, minimally invasive procedures are performed to assess lung lesions and stage lung carcinomas. In cases of advanced-stage lung cancer, the biopsy may provide the only diagnostic tissue. The aim of this study was to determine which method-fine-needle aspiration (FNA), core biopsy (CBx), or both (B)--is optimal for providing sufficient tissue for rendering a specific diagnosis and pursuing molecular studies for guiding tumor-specific treatment.
  
  
  METHODS
  A search was performed for computed tomography-guided lung FNA, CBx, or B cases with rapid onsite evaluation. Carcinomas were assessed for the adequacy to render a specific diagnosis; this was defined as enough refinement to subtype a primary carcinoma or to assess a metastatic origin morphologically and/or immunohistochemically. In cases of primary lung adenocarcinoma, the capability of each modality to yield sufficient tissue for molecular studies (epidermal growth factor receptor, KRAS, or anaplastic lymphoma kinase) was also assessed.
  
  
  RESULTS
  There were 210 cases, and 134 represented neoplasms, including 115 carcinomas. For carcinomas, a specific diagnosis was reached in 89% of FNA cases (33 of 37), 98% of CBx cases (43 of 44), and 100% of B cases (34 of 34). For primary lung adenocarcinomas, adequate tissue remained to perform molecular studies in 94% of FNA cases (16 of 17), 100% of CBx cases (19 of 19), and 86% of B cases (19 of 22). No statistical difference was found among the modalities for either reaching a specific diagnosis (p = .07, Fisher exact test) or providing sufficient tissue for molecular studies (p = .30, Fisher exact test).
  
  
  CONCLUSIONS
  The results suggest that FNA, CBx, and B are comparable for arriving at a specific diagnosis and having sufficient tissue for molecular studies: they specifically attained the diagnostic and prognostic goals of minimally invasive procedures for lung carcinoma.
authors.affiliation: Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York.
authors.forename: Shana M
authors.initials: SM
authors.lastname: Coley
authors.affiliation: Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York.
authors.forename: John P
authors.initials: JP
authors.lastname: Crapanzano
authors.affiliation: Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York.
authors.forename: Anjali
authors.initials: A
authors.lastname: Saqi
mesh_terms: D000230:Adenocarcinoma / Q000235:genetics / Q000473:pathology* / Q000601:surgery; D000077192:Adenocarcinoma of Lung; D000368:Aged; D044963:Biopsy, Fine-Needle / Q000379:methods; D062005:Biopsy, Large-Core Needle; D015331:Cohort Studies; D005260:Female; D005820:Genetic Testing / Q000379:methods; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008175:Lung Neoplasms / Q000235:genetics / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D058990:Molecular Targeted Therapy / Q000379:methods; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D046509:Tissue Culture Techniques; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: KRAS; anaplastic lymphoma kinase (ALK); biopsy; computed tomography (CT)-guided; core biopsy; cytology; epidermal growth factor receptor (EGFR); fine-needle aspiration (FNA); lung cancer; minimally invasive; molecular; small specimen