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A.M. Ridwanuloh
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P3.02b - Poster Session with Presenters Present (ID 494)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)
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P3.02b-033 - Filter Paper as Specimen Storage and Transport Medium of EGFR Mutation Testing Collected from Lung Cancer Patients in Remote Areas of Indonesia (ID 6235)
14:30 - 14:30 | Author(s): A.M. Ridwanuloh
- Abstract
Background:
Indonesian National Insurance and Formulary mandates EGFR molecular testing for all newly diagnosed lung cancer patients. Cytological smears prepared from pleural effusions are routine sources for molecular testing. However, pathological reviews and molecular diagnostics are not always accessible in many Indonesian remote hospitals. We evaluated filter paper as simple storage and transport medium of pleural effusion sediment to central laboratory.
Methods:
Pleural effusions obtained from 16 lung cancer patients were split and prepared in two paralled methods, ie smeared on cytological slides and sedimented into filter paper. Cytological slides were reviewed by a pathologist, who selected areas enriched with tumor cells for DNA extraction. Pleural effusion sedimented on filter papers were air dried and DNA were extracted. EGFR mutation was detected using combined PCR High Resolution Melting (HRM) and Restriction Fragment Length Polymorphism (RFLP) having analytical sensitivity of detecting 3% EGFR mutant alleles. EGFR genotypes obtained from cytological slides were compared with those from filter paper to determine specificity and sensitivity. Another set of 63 pleural effusion specimens collected on filter papers were also evaluated and tested for EGFR mutation.
Results:
EGFR mutations rates from same patients (N=16) using two different methods were 43.75% and 18.75% using cytology and filter paper, respectively. Mutations L858R (5 cases) and L861Q (1 case) were obtained using cytology, and L858R (3 cases) using filter paper. Agreement between two methods were 75% yielding Kappa value 0.458 (moderate). Diagnostic sensitivity and specificity were 42.86% and 100%, respectively. Another set filter papers with sedimented pleural effusions obtained 63 patients showed 15.9% mutation rate.
Conclusion:
Our data demonstrated that filter paper may serve as ancillary medium to store and transport lung specimens for lung patients residing in remote areas and/or where pathology review is not accessible in many parts of Indonesia. In this study, mutation rate (15.9%), sensitivity (42%) and specificity (100%) using filter paper were similar to mutation rate (22%), sensitivity (47%), specificity (96%) obtained from plasma of Asian lung cancer patients as described recently (Han, B et al 2015). High rate of specificity to detect EGFR mutation may inform therapy choice or diagnosis for patients highly suspected with malignancy. However, poor sensitivity of using filter paper as collection medium points out that patients with negative results should be invited and sent to tertiary hospital for further workup.
