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Bronchoscopic Re-biopsy for Mutational Analysis of Non-small Cell Lung Cancer

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Abstract

Objectives

Currently, several acquired resistance mechanisms and rare driver oncogenes are identified in non-small cell lung cancer (NSCLC) relapses. Re-biopsy increases valuable information to guide treatment strategies, but the utility and feasibility of bronchoscopic re-biopsy has not been investigated.

Methods

We studied 70 patients who underwent bronchoscopic for re-biopsy of NSCLC that was resistant to at least one regimen of chemotherapy or molecular-targeted therapy between January 2013 and December 2014. We assessed clinical data, technical success rate, and mutational analysis.

Results

Procedures performed were transbronchial biopsy (n = 52) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS–TBNA) (n = 18). Overall detection rate of re-biopsy for malignant cells was 87 % (83 % for TBB and 100 % for EBUS–TBNA). Mutational analysis was possible in almost all technically successful cases; likewise, acquired-resistant mutations (55 % of EGFR mutants) and small cell lung cancer transformation were identified from the bronchoscopy specimens. Other driver mutations were seen in four cases, including ALK fusion gene (n = 2) and ROS1 fusion gene (n = 2). There were no associated severe complications.

Conclusion

This study shows that bronchoscopic re-biopsy for NSCLC is feasible and provides adequate samples that enable identification of resistance mutations and rare driver oncogenes.

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Acknowledgments

The authors are indebted to Dr. Shinji Sasada and Dr. Christine Chavez for their technical and English review assistants of this manuscript. This work was supported by the National Cancer Center Research and Development Fund (25-A-12).

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Authors and Affiliations

  1. Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, 5-1-1, Tukiji Chou-ku, Tokyo, 104-0045, Japan

    Keisuke Kirita, Takehiro Izumo, Yuji Matsumoto, Yoshihisa Hiraishi & Takaaki Tsuchida

  2. Division of Thoracic Oncology, National Cancer Center Hospital East, Chiba, Japan

    Keisuke Kirita

Authors
  1. Keisuke Kirita
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  2. Takehiro Izumo
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  3. Yuji Matsumoto
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Corresponding author

Correspondence to Takehiro Izumo.

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Kirita, K., Izumo, T., Matsumoto, Y. et al. Bronchoscopic Re-biopsy for Mutational Analysis of Non-small Cell Lung Cancer. Lung 194, 371–378 (2016). https://doi.org/10.1007/s00408-016-9864-5

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  • DOI: https://doi.org/10.1007/s00408-016-9864-5

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