title: Biopsy testing in an inoperable, non-small cell lung cancer population-a retrospective, real-life study in Sweden.
abstract: BACKGROUND
  Correct diagnosis and staging are required for optimal treatment choice in lung cancer patients. This retrospective, patient medical records study investigated the clinical practice of lung cancer biopsy procedures and testing in Sweden.
  
  
  METHODS
  Consecutive patients with a recorded inoperable, malignant tumour of bronchus and lung were retrospectively identified at geographically widespread pulmonology clinics (NCT01139619). Data, including diagnostic sampling methodology [bronchoscopy, biopsy by pulmonologist and computed tomography (CT)-guided biopsy], were collected for patients diagnosed between 1 June 2009-31 May 2010, and analysed using descriptive statistics. A study-predefined algorithm, including six criteria on tumour localization and size, forced expiratory volume in one second (FEV1), blood saturation and risk of bleeding theoretically categorizing patient suitability for CT-guided biopsy, was used.
  
  
  RESULTS
  In total, 132 patients (mean age 68 years, 48% women, 61% adenocarcinoma, 86% current/ former smokers, 96% performance status ≤2, mean FEV1 volume ≥2 L) were included. The majority were examined by >1 diagnostic procedure (29% by CT-guided biopsy). Median overall time from first hospital contact to established diagnosis was 12.0 days (10.0 and 28.0 days for bronchoscopy and CT-guided biopsy, respectively). No major differences in lung function, age, performance status or predefined algorithm criteria were noted for patients examined by CT-guided biopsy versus bronchoscopy or biopsy. Complications were reported for 11 patients, including pneumothorax in six patients. Histopathology was used most frequently to diagnose and subtype (70%), although 66% of patients examined solely by bronchoscopy were diagnosed by cytology. For 26.5% of patients, epidermal growth factor receptor (EGFR) mutation testing was recorded.
  
  
  CONCLUSIONS
  No limitations regarding patient suitability or methodological complications were noted in this real-life, observational study. The CT-guided biopsy is a relatively safe and well-established method, and may need to be utilized further to fulfil current and future demands for faster diagnosis and high quality tissue as new tumour markers and targeted therapies become available.
authors.affiliation: 1 Department of Respiratory Medicine, Gävle Hospital; Centre for Research and Development Uppsala University, County Council of Gävleborg; and Karolinska Institutet, Stockholm, Sweden ; 2 Department of Pathology, Skåne University Hospital, Lund, Sweden ; 3 AstraZeneca NordicBaltic, Södertälje, Sweden ; 4 Department of Radiology, Solna, Karolinska University Hospital; and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Hirsh
authors.initials: H
authors.lastname: Koyi
authors.affiliation: 1 Department of Respiratory Medicine, Gävle Hospital; Centre for Research and Development Uppsala University, County Council of Gävleborg; and Karolinska Institutet, Stockholm, Sweden ; 2 Department of Pathology, Skåne University Hospital, Lund, Sweden ; 3 AstraZeneca NordicBaltic, Södertälje, Sweden ; 4 Department of Radiology, Solna, Karolinska University Hospital; and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Leif
authors.initials: L
authors.lastname: Johansson
authors.affiliation: 1 Department of Respiratory Medicine, Gävle Hospital; Centre for Research and Development Uppsala University, County Council of Gävleborg; and Karolinska Institutet, Stockholm, Sweden ; 2 Department of Pathology, Skåne University Hospital, Lund, Sweden ; 3 AstraZeneca NordicBaltic, Södertälje, Sweden ; 4 Department of Radiology, Solna, Karolinska University Hospital; and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Jesper
authors.initials: J
authors.lastname: From
authors.affiliation: 1 Department of Respiratory Medicine, Gävle Hospital; Centre for Research and Development Uppsala University, County Council of Gävleborg; and Karolinska Institutet, Stockholm, Sweden ; 2 Department of Pathology, Skåne University Hospital, Lund, Sweden ; 3 AstraZeneca NordicBaltic, Södertälje, Sweden ; 4 Department of Radiology, Solna, Karolinska University Hospital; and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Sven
authors.initials: S
authors.lastname: Nyrén
keywords: Non-small cell lung cancer (NSCLC); biopsy; epidermal growth factor receptor (EGFR); medical records; pathology