Fine-needle aspiration of small pulmonary nodules yields material for reliable molecular analysis of adenocarcinomas

Dianne Grunes; David Yankelevitz; Mary Beth Beasley; David Burstein; David Zhang; Fei Ye; Arnold Szporn; Qiusheng Si; Zesong Zhang; Fadi El Salem; Maoxin Wu

doi:10.1016/j.jasc.2015.11.003

Fine-needle aspiration of small pulmonary nodules yields material for reliable molecular analysis of adenocarcinomas

J Am Soc Cytopathol. 2016 Mar-Apr;5(2):57-63. doi: 10.1016/j.jasc.2015.11.003. Epub 2015 Nov 14.

Authors

Dianne Grunes¹, David Yankelevitz², Mary Beth Beasley³, David Burstein⁴, David Zhang⁵, Fei Ye⁶, Arnold Szporn⁴, Qiusheng Si⁴, Zesong Zhang⁴, Fadi El Salem⁴, Maoxin Wu⁷

Affiliations

¹ Department of Pathology, The Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: DianneETGrunes@gmail.com.
² Department of Radiology, The Icahn School of Medicine at Mount Sinai, New York, New York.
³ Department of Pathology, The Icahn School of Medicine at Mount Sinai, New York, New York.
⁴ Department of Pathology, The Icahn School of Medicine at Mount Sinai, New York, New York; Department of Cytopathology, The Icahn School of Medicine at Mount Sinai, New York, New York.
⁵ Department of Pathology, The Icahn School of Medicine at Mount Sinai, New York, New York; Department of Cytopathology, The Icahn School of Medicine at Mount Sinai, New York, New York; Department of Molecular Diagnostics, The Icahn School of Medicine at Mount Sinai, New York, New York.
⁶ Department of Pathology, The Icahn School of Medicine at Mount Sinai, New York, New York; Department of Molecular Diagnostics, The Icahn School of Medicine at Mount Sinai, New York, New York.
⁷ Department of Pathology, The Icahn School of Medicine at Mount Sinai, New York, New York; Department of Cytopathology, The Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: maoxin.wu@stonybrookmedicine.edu.

PMID: 31042492
DOI: 10.1016/j.jasc.2015.11.003

Abstract

Introduction: Early molecular characterization with Kirsten rat sarcoma factor, epidermal growth factor, and anaplastic lymphoma kinase are critical to manage pulmonary adenocarcinoma. Fine-needle aspiration (FNA) of lesions <2 cm are routine in our institution and are used in molecular analysis. We report our experience.

Materials and methods: We searched our databank for primary pulmonary adenocarcinomas diagnosed by FNA between January 2009 and April 2013. Size of the lesion aspirated, molecular results, and sample source (FNA versus surgical specimen) were recorded. We compared the frequency of mutations identified by FNA versus surgical specimens and the frequency of mutations in lesions by size (<1 cm, 1-2 cm, >2 cm).

Results: We identified 397 primary pulmonary adenocarcinomas. Molecular studies were requested by the clinician in 89 (22%) of primary adenocarcinomas. FNAs were used in 55 cases; 51 (93%) yielded sufficient material for molecular studies; surgical tissue were used in 34 cases; 33 (97%) yielded sufficient material for molecular studies. The insufficient specimens came from 2 FNAs of 0.6 cm nodules, an FNA of a 2 cm nodule, and a core biopsy.

Conclusions: FNA was adequate for molecular analysis of small nodules. In nodules greater than 0.6 cm, the adequacy is comparable to surgical tissue. There was no statistically significant change in mutation rate by size (53%-58%). Importantly, FNA of small lesions for cytological diagnosis and molecular analysis is encouraged by our data and experience in order to provide early treatment.

Keywords: Adequacy; EGFR; FNA; KRAS; Molecular testing; Non-small-cell carcinoma; Small nodules.