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J. Berg
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P3.04 - Poster Session/ Biology, Pathology, and Molecular Testing (ID 235)
- Event: WCLC 2015
- Type: Poster
- Track: Biology, Pathology, and Molecular Testing
- Presentations: 2
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.04-030 - Are Experienced Physicians More Likely to Acquire Adequate Tissue Material for EGFR-Testing? (ID 2405)
09:30 - 09:30 | Author(s): J. Berg
- Abstract
Background:
Epidermal Growth Factor Receptor (EGFR) mutation testing is now recommended practice for non-squamous non-small cell lung cancer. The patients with activating EGFR mutations are eligible for targeted personalized treatment offering better survival and quality of life, often with low toxicity. However, little is known about how the physician’s level of experience influences the quality of samples taken for EGFR-analysis and if complicated interventions result in more inadequate samples. We therefore performed a retrospective analysis on correlation between doctors’ experience and tissue quality at a moderately-sized community hospital.
Methods:
The Norwegian Lung Cancer Group (NLCG) recommended EGFR- testing of all patients with non-small cell lung carcinoma from June 2010. In March 2013 squamous cell carcinomas were excluded. Basic demographic data, sample type, test results and procedure related complications were recorded for the period June 2010 to December 2013, and the level of experience (measured as inexperienced physicians having less than 10 procedures per year) of the involved physicians was recorded.
Results:
Material was sent for EGFR analysis for 256 of the 304 eligible patients diagnosed in the period. For a total of 34 patients (13%) the first biopsy was not analyzed at department of molecular pathology due to inadequate tumor material. The tissue collected by experienced physicians was sufficient for EGFR analyses in 91-97.2% (median 93%), compared to 50-90% (median 86.7%) for the less experienced physicians. For image supervised biopsies, non-analyzable samples were more frequent when puncturing small (<3 cm) peripheral tumors than when taken from large central tumors. Of 14 image guided biopsies that were returned because of inadequate tumor tissue, only two had complications: one with bleeding and the other with pneumothorax. Both tumors were peripheral. Of three bronchoscopical biopsies that were returned due to inadequate tumor tissue, one was complicated by major bleeding, in another the patient was very restless during the procedure. The last was uncomplicated.
Conclusion:
Our results show that the quality of image guided biopsies taken by more experienced physicians is better than those taken by doctors with less experience. For small peripheral tumors, the frequency of non-analyzable samples were higher than for large central tumors taken by image guided biopsy.
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P3.04-056 - Some Lung Cancer Patients End up without an EGFR-Mutation Analysis (ID 2394)
09:30 - 09:30 | Author(s): J. Berg
- Abstract
Background:
Lung cancer patients with activating mutations in the EGFR-gene are eligible for targeted therapy with tyrosine kinase inhibitors, and clinicians strive for acquiring enough tumor tissue for the needed diagnostic analyses. However, not all patients have an EGFR-test, and little is known about the subsequent steps for patients with inadequate first biopsy.
Methods:
Data on the diagnostic work-up on all NSCLC patients eligible for EGFR-testing was collected at a medium-sized Norwegian hospital for the period June 2010 to December 2013. For samples without successful EGFR-mutation results, we recorded possible explanations.
Results:
Material was sent for EGFR analysis for 256 of the 304 eligible patients diagnosed in the period. For a total of 34 patients (13%) the first biopsy was not analyzed at the department of molecular pathology due to inadequate tumor material. Of these 34 patients, 23 (65%) had no new sample submitted for analysis. 13 of the 23 (57%) were in stage IV, and of these, three did not want active treatment and one was not a candidate for active treatment because of poor general condition. One patient was not re-biopsied due to rapid disease progression. Eigth patients were for no obvious reason never considered for re-biopsies, including a younger patient who had brain metastases at the time of diagnosis, but who lived for 19 months after diagnosis. One of the 11 sent was diagnosed with activating EGFR mutation in the second sample sent for analyses. For patients with rejected samples, EGFR results were available after 17 - 69 days (median 38) from rejection of the first sampling.
Conclusion:
For 65% of the rejected samples, no new samples were submitted for analysis. 57% of the patients with no new sample taken, were in stage IV. When a new biopsy was planned, our study shows that EGFR results from the new sampling were available after median 38 days. For this patient group, with poor prognosis and often rapid disease progression, one should strive for a new sampling and a quicker turn-around time.
