European Radiology

, Volume 28, Issue 2, pp 861–868 | Cite as

Repeat biopsy of patients with acquired resistance to EGFR TKIs: implications of biopsy-related factors on T790M mutation detection

  • Hyungjin Kim
  • Kum Ju Chae
  • Soon Ho Yoon
  • Miso Kim
  • Bhumsuk Keam
  • Tae Min Kim
  • Dong-Wan Kim
  • Jin Mo Goo
  • Chang Min ParkEmail author



To find predictors of non-diagnostic repeat biopsy specimen acquisition for mutational analysis and detection of epidermal growth factor receptor (EGFR) T790M mutation.


We retrospectively reviewed 90 non-small cell lung cancer patients harbouring EGFR mutations who underwent repeat cone-beam CT-guided transthoracic needle biopsy. Clinical characteristics as well as biopsy-related factors were compared between patients with and without diagnostic specimen acquisition and between patients with and without T790M mutation. After univariate analysis, multivariate logistic regression analysis was performed to reveal independent predictors.


Diagnostic biopsy specimens for mutational test were obtained in 90% (81/90) of patients, of which 62% (50/81) possessed T790M mutation. None of the analysed variables were significantly associated with non-diagnostic specimen acquisition. For T790M detection, duration of EGFR tyrosine kinase inhibitor treatment (p = 0.066), duration of total chemotherapy (p = 0.026), tumour size (p = 0.066), and metastatic lung lesion as a biopsy target (p = 0.029) showed p values less than 0.10. Multivariate analysis revealed that target tumour size (odds ratio, 0.765; p = 0.031) was an independent predictor of T790M mutation. Metastatic lesions as biopsy targets (odds ratio, 4.194; p = 0.050) showed marginal statistical significance.


Non-diagnostic repeat biopsy specimen acquisition was not related to the clinical or technical factors. However, detection of T790M at repeat biopsy might be associated with smaller target tumour size and selection of metastatic lesions as biopsy targets.

Key Points

Cone-beam CT-guided repeat biopsy yielded high diagnostic specimen acquisition rate.

Biopsy-related features were associated with the detection of T790M mutation.

Target tumour size was an independent predictor of the T790M detection.

Biopsy targeting metastatic lung nodules might help detect the T790M mutation.


Non-small-cell lung carcinoma Epidermal growth factor receptor Protein kinase inhibitor Drug resistance Image-guided biopsy 



Overall survival


Non-small cell lung cancer


Epidermal growth factor receptor


Tyrosine kinase inhibitor


Progression-free survival


Adenosine triphosphate


Cone-beam computed tomography


Percutaneous transthoracic needle biopsy


Peptide nucleic acid


Polymerase chain reaction


Standardised uptake value



We would like to thank Chris Woo, B.A., for editorial assistance.

Compliance with ethical standards


The scientific guarantor of this publication is Chang Min Park.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.


This study has received funding by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HC15C3390) and a grant of the Industrial Strategic technology development program, funded by the Ministry of Trade Industry and Energy (MI), Republic of Korea (grant number: 10041618).

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in a journal article (N Engl J Med 372:1689-1699).


• retrospective

• diagnostic or prognostic study

• performed at one institution


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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  1. 1.Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation MedicineSeoul National University Medical Research CentreSeoulKorea
  2. 2.Department of Radiology, Institute of Medical Science, and Research Institute of Clinical MedicineChonbuk National University Medical School and HospitalJeonjuKorea
  3. 3.Seoul National University Cancer Research InstituteSeoulKorea
  4. 4.Department of Internal MedicineSeoul National University HospitalSeoulKorea

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