FNA, core biopsy, or both for the diagnosis of lung carcinoma: Obtaining sufficient tissue for a specific diagnosis and molecular testing

Cancer Cytopathol. 2015 May;123(5):318-26. doi: 10.1002/cncy.21527. Epub 2015 Feb 24.

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.

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.

Publication types

  • Comparative Study

MeSH terms

  • Adenocarcinoma / genetics
  • Adenocarcinoma / pathology*
  • Adenocarcinoma / surgery
  • Adenocarcinoma of Lung
  • Aged
  • Biopsy, Fine-Needle* / methods
  • Biopsy, Large-Core Needle*
  • Cohort Studies
  • Female
  • Genetic Testing / methods
  • Humans
  • Image-Guided Biopsy / methods*
  • Lung Neoplasms / genetics
  • Lung Neoplasms / pathology*
  • Lung Neoplasms / surgery
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures / methods
  • Molecular Targeted Therapy / methods
  • Neoplasm Invasiveness / pathology
  • Neoplasm Staging
  • Pneumonectomy / methods
  • Retrospective Studies
  • Risk Assessment
  • Sensitivity and Specificity
  • Tissue Culture Techniques
  • Tomography, X-Ray Computed / methods