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Soliman MM, Gershon B, Ra DS, Escalon JG, Groner LK, Cahill M, Askin G, Sullivan BW, Pua BB. Imaging Findings Related to Lung Tract Sealant Use in Percutaneous CT-guided Lung Biopsy. Clin Lung Cancer 2025; 26:236-243. [PMID: 39890572 DOI: 10.1016/j.cllc.2025.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2024] [Revised: 12/31/2024] [Accepted: 01/02/2025] [Indexed: 02/03/2025]
Abstract
PURPOSE This study examines the imaging findings and malignancy suspicion associated with hydrogel lung tract sealants (h-LTS) used after CT-guided lung biopsy (CTLB). MATERIALS AND METHODS Charts of patients who underwent CTLB from 01/2016 to 01/2020 were reviewed for biopsy date, h-LTS use, resection, and imaging follow-up. Exclusion criteria included resection <3 months postbiopsy, no imaging ≥3 months, and pleural nodules. Postbiopsy imaging was analyzed for abnormalities at the biopsy tract. Out of 164 patients who underwent CTLB with h-LTS, a random subset of 64 patients (Group A) was anonymized and compared with another randomly selected, anonymized group of 64 patients who underwent CTLB without h-LTS during the study period (Group B) to assess inter-reader agreement. Two cardiothoracic radiologists reviewed the anonymized intraprocedural biopsy CT and follow-up imaging at multiple intervals (3-6, 6-12, 12-24, >24months) for abnormalities along the biopsy tract and associated malignancy suspicion (Categories 1-5 [low-high]). RESULTS A serpiginous lesion was observed along the biopsy tract in 60% (99/164) of patients who received h-LTS, lasting an average of 23.3 months (Range: 3-67). Moderate inter-reader agreement was seen for abnormalities in Group A patients at all follow-up intervals. FDG-PET/CT showed mild uptake for up to 5 years in 46% of patients. At initial follow-up, 17% of h-LTS scars were rated Category 3 or higher suspicion for malignancy. Most h-LTS scars maintained or decreased in suspicion in later follow-ups. CONCLUSION h-LTS is associated with a serpiginous scar, which may be mildly hypermetabolic and last up to 5 years.
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Affiliation(s)
- Mohamed M Soliman
- Division of Interventional Radiology, Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY
| | - Blake Gershon
- Division of Interventional Radiology, Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY
| | - Deirdre Sullivan Ra
- Division of Interventional Radiology, Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY
| | - Joanna G Escalon
- Division of Cardiothoracic Imaging, Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY
| | - Lauren K Groner
- Division of Cardiothoracic Imaging, Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY
| | - Meghan Cahill
- Division of Interventional Radiology, Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY
| | - Gulce Askin
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY; Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Brian W Sullivan
- Division of Interventional Radiology, Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY
| | - Bradley B Pua
- Division of Interventional Radiology, Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY.
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Li Z, Hu S, Leng L, Ding C, Zhao J, Ye L, Song X, Shen Z. Comparison of laser-guided technology and conventional manual percutaneous lung biopsy: a single-center retrospective study. J Thorac Dis 2025; 17:1570-1579. [PMID: 40223984 PMCID: PMC11986727 DOI: 10.21037/jtd-24-1812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Accepted: 01/17/2025] [Indexed: 04/15/2025]
Abstract
Background Percutaneous lung biopsy (PLB) is currently widely utilized in the diagnosis and treatment of lung tumors, owing to its advantages of minimal trauma, high detection rate, and precise localization. However, traditional computed tomography (CT)-guided freehand PLB procedures often involve multiple puncture adjustments and a relatively high incidence of complications. The aim of this study is to investigate whether laser-guided technology can effectively reduce the operative time and incidence of complications. Methods This study included 141 patients who underwent CT-guided PLB at the First Affiliated Hospital of Soochow University between January 2022 and January 2024. These patients were divided into two groups based on the use of laser-guided technology during the procedure: the laser-guided group (47 patients) and the manual group (94 patients). Clinical data from all patients were collected. Information such as the success rate of biopsy procedures and the incidence of complications was analyzed and compared. Results The procedure time in the laser-guided group was shorter than that in the manual group (P=0.008). In the laser-guided group, the number of adjustments needed to reach the tumor during the positioning step was less than the manual group (P=0.001). In the laser-guided group, the number of CT scans performed before reaching the tumor was smaller than in the manual group (P=0.01). The distance from the first puncture to the lung tumor in the laser-guided group was closer than that in the manual group (P=0.049). The laser-guided group had a smaller angular deviation from the target at the first puncture than the manual group (P=0.004). Conclusions Laser-guided technology has the advantages of shorter operation time and less adjustment of biopsy needles. However, laser-guided technology does not reduce the complication rate of biopsy surgery or the length of hospital stay after surgery and there is no statistical difference in the accuracy of pathological diagnoses obtained by the two methods.
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Affiliation(s)
- Zijian Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, China
| | - Shuo Hu
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, China
| | - Lei Leng
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, China
| | - Cheng Ding
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, China
| | - Jun Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, China
| | - Li Ye
- Department of Marketing, Neorad Medical Technology (Shanghai) Co., Ltd., Shanghai, China
| | - Xinyu Song
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, China
| | - Ziqing Shen
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, China
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Kim YG, Lee B, Ha C, Lee C, Jung HA, Sun JM, Lee SH, Ahn MJ, Choi YL, Park S, Kim JW. Clinical utility of circulating tumor DNA profiling in detecting targetable fusions in non-small cell lung cancer. Front Oncol 2024; 14:1463341. [PMID: 39507756 PMCID: PMC11540554 DOI: 10.3389/fonc.2024.1463341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 10/09/2024] [Indexed: 11/08/2024] Open
Abstract
Introduction Numerous studies have suggested high concordance between tissue and circulating tumor DNA (ctDNA) comprehensive genomic profiling (CGP) tests but only few of them focused on fusions. In addition, atypical breakpoints occasionally detected from DNA-based fusion detection make interpretation difficult, and their clinical significance remains unclear. This study evaluated the clinical utility of ctDNA CGP for fusion detection. Methods The results of ctDNA CGP tests performed on patients with stage IV non-small cell lung cancer during routine clinical care were retrospectively reviewed. The concordance between ctDNA CGP and combined tissue test results was analyzed using CGP, immunohistochemistry, fluorescence in situ hybridization, and reverse transcription polymerase chain reaction. The clinical significance of fusions detected by ctDNA CGP, including those with atypical breakpoints at the DNA level, was assessed. Results In total, 264 patients were tested with ctDNA CGP. Fusions were detected in 27 patients (10.2%), and the fusion drivers were RET (n=12, 4.6%), ALK (n=9, 3.4%), ROS1 (n=4, 1.5%), and FGFR2 (n=2, 0.8%). The overall prevalence of fusion in tissue CGP was comparable to that in ctDNA CGP. A total of 371 ctDNA-tissue test pairs were available, and the overall positive and negative percent agreement rates were 92.9% (13/14) and 100.0% (357/357), respectively. One ALK IHC-positive and ctDNA CGP-negative case did not respond to ALK-targeted therapy. Response to targeted therapy was assessed in 16 patients, and a partial response was achieved in all patients, including four with atypical breakpoints. Conclusion Fusion detection using ctDNA CGP showed high concordance with tissue tests and accuracy in predicting therapeutic responses in patients with non-small cell lung cancer. ctDNA CGP may provide an important diagnostic tool for fusion detection.
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Affiliation(s)
- Young-gon Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Boram Lee
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Changhee Ha
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Cheonghwa Lee
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Ae Jung
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong-Mu Sun
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Se-Hoon Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Myung-Ju Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yoon-La Choi
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sehhoon Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong-Won Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Jang D, Darling R, Choudhary G, Jankowich M. Hemorrhagic Adverse Events of Transthoracic Needle Biopsy of the Lung in Patients with Pulmonary Hypertension: A Systematic Review and Meta-Analysis. J Vasc Interv Radiol 2024; 35:1139-1146.e3. [PMID: 38685471 DOI: 10.1016/j.jvir.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/22/2024] [Accepted: 04/21/2024] [Indexed: 05/02/2024] Open
Abstract
PURPOSE To compare the risk of hemorrhagic adverse events of transthoracic needle biopsy (TTNB) such as pulmonary hemorrhage and hemoptysis between patients with pulmonary hypertension (PH) and patients without PH. MATERIALS AND METHODS Database search and citation review of search results were performed for studies reporting frequency of hemorrhagic adverse events of TTNB in adult patients with evidence of PH compared with that in patients undergoing the procedure without evidence of PH. Random-effects meta-analysis was performed for both rates of pulmonary hemorrhage and hemoptysis. RESULTS A total of 5 studies (encompassing 6,250 patients who underwent 6,684 biopsies) were included. All studies were retrospective and used computed tomography (CT) or echocardiography for identification of signs of PH. Biopsy-related pulmonary hemorrhage was diagnosed radiographically, and postbiopsy hemoptysis was diagnosed by documentation in the medical record. There were no differences found between patients with evidence of PH and those without regarding rates of pulmonary hemorrhage (odds ratio [OR], 1.12 [95% confidence interval {CI}, 0.85-1.47] in studies that used CT to define PH, and OR, 0.88 [95% CI 0.56-1.39] in studies that used echocardiography to define PH). There were also no differences in the rates of hemoptysis (OR, 0.95 [95% CI, 0.46-1.97]). CONCLUSIONS A systematic review and meta-analysis of the literature did not demonstrate that patients with imaging evidence of PH undergoing TTNB had an increased risk of hemorrhagic adverse events.
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Affiliation(s)
- Daniel Jang
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
| | - Rachel Darling
- Division of Pulmonary, Critical Care and Sleep Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Gaurav Choudhary
- Division of Cardiology, Providence Veterans Affairs Medical Center and Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Matthew Jankowich
- Division of Pulmonary and Critical Care Medicine, Providence Veterans Affairs Medical Center and Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Peters S, Gadgeel SM, Mok T, Nadal E, Kilickap S, Swalduz A, Cadranel J, Sugawara S, Chiu CH, Yu CJ, Moskovitz M, Tanaka T, Nersesian R, Shagan SM, Maclennan M, Mathisen M, Bhagawati-Prasad V, Diarra C, Assaf ZJ, Archer V, Dziadziuszko R. Entrectinib in ROS1-positive advanced non-small cell lung cancer: the phase 2/3 BFAST trial. Nat Med 2024; 30:1923-1932. [PMID: 38898120 PMCID: PMC11271410 DOI: 10.1038/s41591-024-03008-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 04/18/2024] [Indexed: 06/21/2024]
Abstract
Although comprehensive biomarker testing is recommended for all patients with advanced/metastatic non-small cell lung cancer (NSCLC) before initiation of first-line treatment, tissue availability can limit testing. Genomic testing in liquid biopsies can be utilized to overcome the inherent limitations of tissue sampling and identify the most appropriate biomarker-informed treatment option for patients. The Blood First Assay Screening Trial is a global, open-label, multicohort trial that evaluates the efficacy and safety of multiple therapies in patients with advanced/metastatic NSCLC and targetable alterations identified by liquid biopsy. We present data from Cohort D (ROS1-positive). Patients ≥18 years of age with stage IIIB/IV, ROS1-positive NSCLC detected by liquid biopsies received entrectinib 600 mg daily. At data cutoff (November 2021), 55 patients were enrolled and 54 had measurable disease. Cohort D met its primary endpoint: the confirmed objective response rate (ORR) by investigator was 81.5%, which was consistent with the ORR from the integrated analysis of entrectinib (investigator-assessed ORR, 73.4%; data cutoff May 2019, ≥12 months of follow-up). The safety profile of entrectinib was consistent with previous reports. These results demonstrate consistency with those from the integrated analysis of entrectinib in patients with ROS1-positive NSCLC identified by tissue-based testing, and support the clinical value of liquid biopsies to inform clinical decision-making. The integration of liquid biopsies into clinical practice provides patients with a less invasive diagnostic method than tissue-based testing and has faster turnaround times that may expedite the reaching of clinical decisions in the advanced/metastatic NSCLC setting. ClinicalTrials.gov registration: NCT03178552 .
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Affiliation(s)
- Solange Peters
- Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
| | - Shirish M Gadgeel
- Henry Ford Cancer Institute/Henry Ford Health System, Detroit, MI, USA
| | - Tony Mok
- State Laboratory of Translational Oncology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Hong Kong SAR
| | - Ernest Nadal
- Thoracic Oncology Unit, Department of Medical Oncology, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Saadettin Kilickap
- Department of Medical Oncology, Instinye University Faculty of Medicine, Istanbul, Turkey
| | - Aurélie Swalduz
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Jacques Cadranel
- Department of Pneumology and Thoracic Oncology, APHP, Hôpital Tenon and GRC04 Theranoscan Sorbonne Université, Paris, France
| | - Shunichi Sugawara
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Chao-Hua Chiu
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Taipei Cancer Center and Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Mor Moskovitz
- Thoracic Cancer Service, Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
| | | | | | | | | | | | | | | | | | | | - Rafal Dziadziuszko
- Department of Oncology and Radiotherapy and Early Clinical Trials Unit, Medical University of Gdansk, Gdansk, Poland
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6
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Luo X, Zheng R, Zhang J, He J, Luo W, Jiang Z, Li Q. CT-based radiomics for predicting Ki-67 expression in lung cancer: a systematic review and meta-analysis. Front Oncol 2024; 14:1329801. [PMID: 38384802 PMCID: PMC10879429 DOI: 10.3389/fonc.2024.1329801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/22/2024] [Indexed: 02/23/2024] Open
Abstract
Background Radiomics, an emerging field, presents a promising avenue for the accurate prediction of biomarkers in different solid cancers. Lung cancer remains a significant global health challenge, contributing substantially to cancer-related mortality. Accurate assessment of Ki-67, a marker reflecting cellular proliferation, is crucial for evaluating tumor aggressiveness and treatment responsiveness, particularly in non-small cell lung cancer (NSCLC). Methods A systematic review and meta-analysis conducted following the preferred reporting items for systematic review and meta-analysis of diagnostic test accuracy studies (PRISMA-DTA) guidelines. Two authors independently conducted a literature search until September 23, 2023, in PubMed, Embase, and Web of Science. The focus was on identifying radiomics studies that predict Ki-67 expression in lung cancer. We evaluated quality using both Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) and the Radiomics Quality Score (RQS) tools. For statistical analysis in the meta-analysis, we used STATA 14.2 to assess sensitivity, specificity, heterogeneity, and diagnostic values. Results Ten retrospective studies were pooled in the meta-analysis. The findings demonstrated that the use of computed tomography (CT) scan-based radiomics for predicting Ki-67 expression in lung cancer exhibited encouraging diagnostic performance. Pooled sensitivity, specificity, and area under the curve (AUC) in training cohorts were 0.78, 0.81, and 0.85, respectively. In validation cohorts, these values were 0.78, 0.70, and 0.81. Quality assessment using QUADAS-2 and RQS indicated generally acceptable study quality. Heterogeneity in training cohorts, attributed to factors like contrast-enhanced CT scans and specific Ki-67 thresholds, was observed. Notably, publication bias was detected in the training cohort, indicating that positive results are more likely to be published than non-significant or negative results. Thus, journals are encouraged to publish negative results as well. Conclusion In summary, CT-based radiomics exhibit promise in predicting Ki-67 expression in lung cancer. While the results suggest potential clinical utility, additional research efforts should concentrate on enhancing diagnostic accuracy. This could pave the way for the integration of radiomics methods as a less invasive alternative to current procedures like biopsy and surgery in the assessment of Ki-67 expression.
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Affiliation(s)
- Xinmin Luo
- Department of Radiology, People’s Hospital of Yuechi County, Guang’an, Sichuan, China
| | - Renying Zheng
- Department of Oncology, People’s Hospital of Yuechi County, Guang’an, Sichuan, China
| | - Jiao Zhang
- Department of Radiology, People’s Hospital of Yuechi County, Guang’an, Sichuan, China
| | - Juan He
- Department of Radiology, People’s Hospital of Yuechi County, Guang’an, Sichuan, China
| | - Wei Luo
- Department of Radiology, People’s Hospital of Yuechi County, Guang’an, Sichuan, China
| | - Zhi Jiang
- Department of Radiology, People’s Hospital of Yuechi County, Guang’an, Sichuan, China
| | - Qiang Li
- Department of Radiology, Yuechi County Traditional Chinese Medicine Hospital in Sichuan Province, Guang’an, Sichuan, China
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Bajo-Fernández M, Souza-Silva ÉA, Barbas C, Rey-Stolle MF, García A. GC-MS-based metabolomics of volatile organic compounds in exhaled breath: applications in health and disease. A review. Front Mol Biosci 2024; 10:1295955. [PMID: 38298553 PMCID: PMC10828970 DOI: 10.3389/fmolb.2023.1295955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 12/05/2023] [Indexed: 02/02/2024] Open
Abstract
Exhaled breath analysis, with particular emphasis on volatile organic compounds, represents a growing area of clinical research due to its obvious advantages over other diagnostic tests. Numerous pathologies have been extensively investigated for the identification of specific biomarkers in exhalates through metabolomics. However, the transference of breath tests to clinics remains limited, mainly due to deficiency in methodological standardization. Critical steps include the selection of breath sample types, collection devices, and enrichment techniques. GC-MS is the reference analytical technique for the analysis of volatile organic compounds in exhalates, especially during the biomarker discovery phase in metabolomics. This review comprehensively examines and compares metabolomic studies focusing on cancer, lung diseases, and infectious diseases. In addition to delving into the experimental designs reported, it also provides a critical discussion of the methodological aspects, ranging from the experimental design and sample collection to the identification of potential pathology-specific biomarkers.
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Affiliation(s)
- María Bajo-Fernández
- Centro de Metabolómica y Bioanálisis (CEMBIO), Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, Boadilla del Monte, Spain
| | - Érica A. Souza-Silva
- Centro de Metabolómica y Bioanálisis (CEMBIO), Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, Boadilla del Monte, Spain
- Departmento de Química, Universidade Federal de São Paulo (UNIFESP), Diadema, Brazil
| | - Coral Barbas
- Centro de Metabolómica y Bioanálisis (CEMBIO), Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, Boadilla del Monte, Spain
| | - Ma Fernanda Rey-Stolle
- Centro de Metabolómica y Bioanálisis (CEMBIO), Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, Boadilla del Monte, Spain
| | - Antonia García
- Centro de Metabolómica y Bioanálisis (CEMBIO), Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, Boadilla del Monte, Spain
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Smith S, Boyer M, Kao S. Re-re-biopsy? How much tumor is enough in the era of precision oncology? Asia Pac J Clin Oncol 2023; 19:581-584. [PMID: 37784252 DOI: 10.1111/ajco.14030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/23/2023] [Indexed: 10/04/2023]
Affiliation(s)
- Samuel Smith
- Department of Medical Oncology, St Vincent's Hospital, Melbourne, Australia
| | - Michael Boyer
- Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, Australia
- Faculty of Medicine and Health, School of Medicine, University of Sydney, Sydney, Australia
| | - Steven Kao
- Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, Australia
- Faculty of Medicine and Health, School of Medicine, University of Sydney, Sydney, Australia
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Lalić N, Lovrenski A, Ilić M, Ivanov O, Bojović M, Lalić I, Popević S, Stjepanović M, Janjić N. Invasive Diagnostic Procedures from Bronchoscopy to Surgical Biopsy-Optimization of Non-Small Cell Lung Cancer Samples for Molecular Testing. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1723. [PMID: 37893442 PMCID: PMC10608158 DOI: 10.3390/medicina59101723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Treatment of advanced lung cancer (LC) has become increasingly personalized over the past decade due to an improved understanding of tumor molecular biology and antitumor immunity. The main task of a pulmonologist oncologist is to establish a tumor diagnosis and, ideally, to confirm the stage of the disease with the least invasive technique possible. Materials and Methods: The paper will summarize published reviews and original papers, as well as published clinical studies and case reports, which studied the role and compared the methods of invasive pulmonology diagnostics to obtain adequate tumor tissue samples for molecular analysis, thereby determining the most effective molecular treatments. Results: Bronchoscopy is often recommended as the initial diagnostic procedure for LC. If the tumor is endoscopically visible, the biopsy sample is susceptible to molecular testing, the same as tumor tissue samples obtained from surgical resection and mediastinoscopy. The use of new sampling methods, such as cryobiopsy for peripheral tumor lesions or cytoblock obtained by ultrasound-guided transbronchial needle aspiration (TBNA), enables obtaining adequate small biopsies and cytological samples for molecular testing, which have until recently been considered unsuitable for this type of analysis. During LC patients' treatment, resistance occurs due to changes in the mutational tumor status or pathohistological tumor type. Therefore, the repeated taking of liquid biopsies for molecular analysis or rebiopsy of tumor tissue for new pathohistological and molecular profiling has recently been mandated. Conclusions: In thoracic oncology, preference should be given to the least invasive diagnostic procedure providing a sample for histology rather than for cytology. However, there is increasing evidence that, when properly processed, cytology samples can be sufficient for both the cancer diagnosis and molecular analyses. A good knowledge of diagnostic procedures is essential for LC diagnosing and treatment in the personalized therapy era.
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Affiliation(s)
- Nensi Lalić
- Faculty of Medicine in Novi Sad, University of Novi Sad, Hajduk Veljkova 3, 21137 Novi Sad, Serbia; (A.L.); (M.I.); (O.I.); (M.B.); (N.J.)
- Institute for Pulmonary Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Aleksandra Lovrenski
- Faculty of Medicine in Novi Sad, University of Novi Sad, Hajduk Veljkova 3, 21137 Novi Sad, Serbia; (A.L.); (M.I.); (O.I.); (M.B.); (N.J.)
- Institute for Pulmonary Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Miroslav Ilić
- Faculty of Medicine in Novi Sad, University of Novi Sad, Hajduk Veljkova 3, 21137 Novi Sad, Serbia; (A.L.); (M.I.); (O.I.); (M.B.); (N.J.)
- Institute for Pulmonary Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Olivera Ivanov
- Faculty of Medicine in Novi Sad, University of Novi Sad, Hajduk Veljkova 3, 21137 Novi Sad, Serbia; (A.L.); (M.I.); (O.I.); (M.B.); (N.J.)
- Clinic of Radiation Oncology, Oncology Institute of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Marko Bojović
- Faculty of Medicine in Novi Sad, University of Novi Sad, Hajduk Veljkova 3, 21137 Novi Sad, Serbia; (A.L.); (M.I.); (O.I.); (M.B.); (N.J.)
- Clinic of Radiation Oncology, Oncology Institute of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Ivica Lalić
- Faculty of Pharmacy, University Business Academy in Novi Sad, Trg Mladenaca 5, 21101 Novi Sad, Serbia;
| | - Spasoje Popević
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (S.P.); (M.S.)
- University Hospital of Pulmonology, Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Mihailo Stjepanović
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (S.P.); (M.S.)
- University Hospital of Pulmonology, Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Nataša Janjić
- Faculty of Medicine in Novi Sad, University of Novi Sad, Hajduk Veljkova 3, 21137 Novi Sad, Serbia; (A.L.); (M.I.); (O.I.); (M.B.); (N.J.)
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10
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Touchet TJ, Brinson B, Jones M, Byju A, Fletcher G, Hasan SM, Nash LD, Maitland DJ. Development of Biopsy Tract Sealants Based on Shape Memory Polymer Foams. BIOMEDICAL MATERIALS & DEVICES (NEW YORK, N.Y.) 2023; 1:853-860. [PMID: 38130883 PMCID: PMC10732340 DOI: 10.1007/s44174-023-00064-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/24/2023] [Indexed: 12/23/2023]
Abstract
Lung biopsies are often used to aid in the diagnosis of cancers. However, the procedure carries the dual risk of air (pneumothorax) or blood (hemothorax) filling the pleural cavity, increasing the risk of a collapsed lung and chest intubation. This work demonstrates the effectiveness of a polyurethane-based shape memory polymer foam as a biopsy tract sealant. The impact of diameter, length, pore size, and shape memory effect was evaluated to determine the ideal device design for tract sealing. Characterization in an in vitro benchtop lung model identified that diameter had the largest influence on sealing efficacy, while the length of the device had little to no impact. Finally, evaluation of deployment force demonstrated that devices fabricated from the shape memory polymer foams were easier to deploy than elastic foams. Following characterization, down-selected device designs were combined with radiopaque markers for use in image-guided based procedures. Furthermore, the introduction of the markers or sterilization did not impact the ability of the devices to seal the biopsy tract and led to a decrease in the deployment force. Overall, these results demonstrate the potential for polyurethane-based shape memory foam devices to serve as biopsy tract sealant devices that aim to reduce complications, such as pneumothorax, from occurring.
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Affiliation(s)
- Tyler J. Touchet
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843
| | - Braeden Brinson
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843
| | - McKenzie Jones
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843
| | - Achu Byju
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843
| | - Grace Fletcher
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843
| | | | | | - Duncan J. Maitland
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843
- Shape Memory Medical, Inc., Santa Clara, CA 95054, USA
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11
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Douglas MP, Ragavan MV, Chen C, Kumar A, Gray SW, Blakely CM, Phillips KA. Private Payer and Medicare Coverage Policies for Use of Circulating Tumor DNA Tests in Cancer Diagnostics and Treatment. J Natl Compr Canc Netw 2023; 21:609-616.e4. [PMID: 37308126 PMCID: PMC10846388 DOI: 10.6004/jnccn.2023.7011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 02/07/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Circulating tumor DNA (ctDNA) is used to select initial targeted therapy, identify mechanisms of therapeutic resistance, and measure minimal residual disease (MRD) after treatment. Our objective was to review private and Medicare coverage policies for ctDNA testing. METHODS Policy Reporter was used to identify coverage policies (as of February 2022) from private payers and Medicare Local Coverage Determinations (LCDs) for ctDNA tests. We abstracted data regarding policy existence, ctDNA test coverage, cancer types covered, and clinical indications. Descriptive analyses were performed by payer, clinical indication, and cancer type. RESULTS A total of 71 of 1,066 total policies met study inclusion criteria, of which 57 were private policies and 14 were Medicare LCDs; 70% of private policies and 100% of Medicare LCDs covered at least one indication. Among 57 private policies, 89% specified a policy for at least 1 clinical indication, with coverage for ctDNA for initial treatment selection most common (69%). Of 40 policies addressing progression, coverage was provided 28% of the time, and of 20 policies addressing MRD, coverage was provided 65% of the time. Non-small cell lung cancer (NSCLC) was the cancer type most frequently covered for initial treatment (47%) and progression (60%). Among policies with ctDNA coverage, coverage was restricted to patients without available tissue or in whom biopsy was contraindicated in 91% of policies. MRD was commonly covered for hematologic malignancies (30%) and NSCLC (25%). Of the 14 Medicare LCD policies, 64% provided coverage for initial treatment selection and progression, and 36% for MRD. CONCLUSIONS Some private payers and Medicare LCDs provide coverage for ctDNA testing. Private payers frequently cover testing for initial treatment, especially for NSCLC, when tissue is insufficient or biopsy is contraindicated. Coverage remains variable across payers, clinical indications, and cancer types despite inclusion in clinical guidelines, which could impact delivery of effective cancer care.
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Affiliation(s)
- Michael P. Douglas
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California
| | - Meera V. Ragavan
- Division of Hematology/Oncology, University of California San Francisco, San Francisco, California
| | - Cheng Chen
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California
- Department of Clinical Pharmacy, UCSF Center for Translational and Policy Research on Precision Medicine (TRANSPERS), San Francisco, California
| | - Anika Kumar
- UCSF School of Medicine, San Francisco, California
| | - Stacy W. Gray
- Department of Population Science, City of Hope, Duarte, California
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California
| | - Collin M. Blakely
- Division of Hematology/Oncology, University of California San Francisco, San Francisco, California
- UCSF Thoracic Oncology Program, University of California San Francisco, San Francisco, California
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Kathryn A. Phillips
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California
- Department of Clinical Pharmacy, UCSF Center for Translational and Policy Research on Precision Medicine (TRANSPERS), San Francisco, California
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
- UCSF Philip R. Lee Institute for Health Policy, San Francisco, California
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12
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Jungmann M, Recalde Phillips S, Touchet TJ, Brinson B, Parish K, Petersen C, Hasan SM, Nash LD, Maitland DJ, Alge DL. Swellable and Thermally Responsive Hydrogel/Shape Memory Polymer Foam Composites for Sealing Lung Biopsy Tracts. ACS Biomater Sci Eng 2023; 9:642-650. [PMID: 36729490 PMCID: PMC10726527 DOI: 10.1021/acsbiomaterials.2c01369] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/19/2023] [Indexed: 02/03/2023]
Abstract
Lung tissue biopsies can result in a leakage of blood (hemothorax) and air (pneumothorax) from the biopsy tract, which threatens the patient with a collapsed lung and other complications. We have developed a lung biopsy tract sealant based on a thiol-ene-crosslinked PEG hydrogel and polyurethane shape memory polymer (SMP) foam composite. After insertion into biopsy tracts, the PEG hydrogel component contributes to sealing through water-driven swelling, whereas the SMP foam contributes to sealing via thermal actuation. The gelation kinetics, swelling properties, and rheological properties of various hydrogel formulations were studied to determine the optimal formulation for composite fabrication. Composites were then fabricated via vacuum infiltration of the PEG hydrogel precursors into the SMP foam followed by thermal curing. After drying, the composites were crimped to enable insertion into biopsy tracts. Characterization revealed that the composites exhibited a slight delay in shape recovery compared to control SMP foams. However, the composites were still able to recover their shape in a matter of minutes. Cytocompatibility testing showed that leachable byproducts can be easily removed by washing and washed composites were not cytotoxic to mouse lung fibroblasts (L929s). Benchtop testing demonstrated that the composites can be easily deployed through a cannula, and the working time for deployment after exposure to water was 2 min. Furthermore, testing in an in vitro lung model demonstrated that the composites were able to effectively seal a lung biopsy tract and prevent air leakage. Collectively, these results show that the PEG hydrogel/SMP foam composites have the potential to be used as lung biopsy tract sealants to prevent pneumothorax post-lung biopsy.
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Affiliation(s)
- Matthew
A. Jungmann
- Department
of Biomedical Engineering, Texas A&M
University, College
Station, Texas 77843, United States
| | - Sarea Recalde Phillips
- Department
of Biomedical Engineering, Texas A&M
University, College
Station, Texas 77843, United States
| | - Tyler J. Touchet
- Department
of Biomedical Engineering, Texas A&M
University, College
Station, Texas 77843, United States
| | - Braeden Brinson
- Department
of Biomedical Engineering, Texas A&M
University, College
Station, Texas 77843, United States
| | - Katherine Parish
- Department
of Chemical Engineering, Texas A&M University, College Station, Texas 77843, United States
| | - Corinne Petersen
- Department
of Biomedical Engineering, Texas A&M
University, College
Station, Texas 77843, United States
| | | | - Landon D. Nash
- Shape
Memory Medical, Inc., Santa Clara, California 95054, United States
| | - Duncan J. Maitland
- Department
of Biomedical Engineering, Texas A&M
University, College
Station, Texas 77843, United States
- Shape
Memory Medical, Inc., Santa Clara, California 95054, United States
| | - Daniel L. Alge
- Department
of Biomedical Engineering, Texas A&M
University, College
Station, Texas 77843, United States
- Department
of Materials Science & Engineering, Texas A&M University, College Station, Texas 77843, United States
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13
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Fintelmann FJ, Martin NA, Tahir I, Quinn EM, Allen TC, Joseph L, Nikolic B, Lee C. Optimizing molecular testing of lung cancer needle biopsy specimens: potential solutions from an interdisciplinary qualitative study. Respir Res 2023; 24:17. [PMID: 36650544 PMCID: PMC9847026 DOI: 10.1186/s12931-023-02321-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Molecular testing can detect actionable genomic alterations and tumor cell surface proteins in patients with non-small cell lung cancer (NSCLC). However, utilization remains suboptimal, representing missed treatment opportunities. This study aimed to identify challenges and potential solutions to obtaining percutaneous lung needle biopsy specimens for successful molecular testing in patients with advanced NSCLC. METHODS This interdisciplinary qualitative study included ten radiologists and four pathologists from academic and community settings across the United States who routinely perform and analyze percutaneous lung needle biopsies. Participants underwent semi-structured one-on-one interviews (Phase 1). Interview questionnaires were constructed based on a literature review of key lines of inquiry and conducted by professional market researchers using the theoretical domains framework. Primary barriers to molecular testing were identified using thematic analysis. Subsequently, multidisciplinary focus groups were convened to identify potential solutions (Phase 2). RESULTS Four themes emerged as barriers to molecular testing and were matched to the clinical workflow: (1) biopsy request, (2) biopsy procedure, (3) specimen analysis, and (4) communication. The nineteen potential solutions included adding a "checkbox" to indicate molecular testing in the biopsy request, leveraging pre-procedural imaging to guide biopsies, conserving tissue through appropriate allocation strategies and next generation sequencing panels instead of sequential single-gene assays, instituting reflex-molecular testing upon NSCLC diagnosis, tracking and communicating biopsy outcomes at multidisciplinary tumor boards, and improving integration of radiologists and pathologists into oncology care teams. CONCLUSIONS Potential solutions exist to increase successful molecular testing of lung needle biopsy specimens in patients with advanced NSCLC.
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Affiliation(s)
- Florian J. Fintelmann
- grid.32224.350000 0004 0386 9924Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
| | - Nikki A. Martin
- grid.443873.f0000 0004 0422 4933LUNGevity Foundation, Bethesda, MD USA
| | - Ismail Tahir
- grid.32224.350000 0004 0386 9924Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
| | - Elissa M. Quinn
- grid.497611.c0000 0004 1794 1958Blueprint Medicines, Boston, MA USA
| | | | - Lija Joseph
- grid.461527.30000 0004 0383 4123Lowell General Hospital, Lowell, MA USA
| | - Boris Nikolic
- grid.439147.c0000 0004 0628 7583Wyoming Valley Radiology Associates, Wilkes-Barre General Hospital, Wilkes-Barre, PA USA
| | - Christopher Lee
- grid.50956.3f0000 0001 2152 9905Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA USA
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14
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Liquid biopsy and non-small cell lung cancer: are we looking at the tip of the iceberg? Br J Cancer 2022; 127:383-393. [PMID: 35264788 PMCID: PMC9345955 DOI: 10.1038/s41416-022-01777-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 02/16/2022] [Accepted: 02/22/2022] [Indexed: 12/15/2022] Open
Abstract
The possibility to analyse the tumour genetic material shed in the blood is undoubtedly one of the main achievements of translational research in the latest years. In the modern clinical management of advanced non-small cell lung cancer, molecular characterisation plays an essential role. In parallel, immunotherapy is widely employed, but reliable predictive markers are not available yet. Liquid biopsy has the potential to face the two issues and to increase its role in advanced NSCLC in the next future. The aim of this review is to summarise the main clinical applications of liquid biopsy in advanced non-small cell lung cancer, underlining both its potential and limitations from a clinically driven perspective.
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15
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Van der Linden M, Van Gaever B, Raman L, Vermaelen K, Demedts I, Surmont V, Himpe U, Lievens Y, Ferdinande L, Dedeurwaerdere F, Van der Meulen J, Claes K, Menten B, Van Dorpe J. Application of an Ultrasensitive NGS-Based Blood Test for the Diagnosis of Early-Stage Lung Cancer: Sensitivity, a Hurdle Still Difficult to Overcome. Cancers (Basel) 2022; 14:cancers14082031. [PMID: 35454937 PMCID: PMC9026713 DOI: 10.3390/cancers14082031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/12/2022] [Accepted: 04/12/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Currently, an accurate diagnosis of lung cancer relies on the microscopic examination of tissue biopsies. These samples can, however, only be obtained by invasive procedures. The aim of our study was to evaluate the use of a liquid biopsy for early-stage lung cancer detection in patients with a lung lesion on imaging. This approach would be particularly relevant for suspected lung lesions that are difficult to reach for a tissue-based diagnosis. Despite technical improvements for the use of liquid biopsy-based cell-free DNA analysis, its application for the detection of early-stage lung cancer is currently limited by sensitivity and a biological background of somatic variants. Abstract Diagnosis of lung cancer requires histological examination of a tissue sample, which in turn requires an invasive procedure that cannot always be obtained. Circulating tumor DNA can be reliably detected in blood samples of advanced-stage lung cancer patients and might also be a minimally invasive alternative for early-stage lung cancer detection. We wanted to explore the potential of targeted deep sequencing as a test for the diagnosis of early-stage lung cancer in combination with imaging. Mutation detection on cell-free DNA from pretreatment plasma samples of 51 patients with operable non-small cell lung cancer was performed and results were compared with 12 control patients undergoing surgery for a non-malignant lung lesion. By using a variant allele frequency threshold of 1%, somatic variants were detected in 23.5% of patients with a median variant allele fraction of 3.65%. By using this threshold, we could almost perfectly discriminate early-stage lung cancer patients from controls. Our study results are discussed in the light of those from other studies. Notwithstanding the potential of today’s techniques for the use of liquid biopsy-based cell-free DNA analysis, sensitivity of this application for early-stage lung cancer detection is currently limited by a biological background of somatic variants with low variant allele fraction.
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Affiliation(s)
- Malaïka Van der Linden
- Department of Diagnostic Sciences, Ghent University, 9000 Ghent, Belgium; (M.V.d.L.); (B.V.G.); (L.R.); (L.F.)
- Cancer Research Institute Ghent, 9000 Ghent, Belgium; (K.V.); (Y.L.); (J.V.d.M.); (K.C.)
| | - Bram Van Gaever
- Department of Diagnostic Sciences, Ghent University, 9000 Ghent, Belgium; (M.V.d.L.); (B.V.G.); (L.R.); (L.F.)
- Department of Pathology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Lennart Raman
- Department of Diagnostic Sciences, Ghent University, 9000 Ghent, Belgium; (M.V.d.L.); (B.V.G.); (L.R.); (L.F.)
| | - Karim Vermaelen
- Cancer Research Institute Ghent, 9000 Ghent, Belgium; (K.V.); (Y.L.); (J.V.d.M.); (K.C.)
- Department of Pulmonary Medicine, Ghent University Hospital, 9000 Ghent, Belgium;
- Department of Internal Medicine and Pediatrics, Ghent University, 9000 Ghent, Belgium
| | - Ingel Demedts
- Department of Pulmonary Medicine, AZ Delta, 8800 Roeselare, Belgium; (I.D.); (U.H.)
| | - Veerle Surmont
- Department of Pulmonary Medicine, Ghent University Hospital, 9000 Ghent, Belgium;
- Department of Internal Medicine and Pediatrics, Ghent University, 9000 Ghent, Belgium
| | - Ulrike Himpe
- Department of Pulmonary Medicine, AZ Delta, 8800 Roeselare, Belgium; (I.D.); (U.H.)
| | - Yolande Lievens
- Cancer Research Institute Ghent, 9000 Ghent, Belgium; (K.V.); (Y.L.); (J.V.d.M.); (K.C.)
- Department of Radiation Oncology, Ghent University Hospital, 9000 Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, 9000 Ghent, Belgium
| | - Liesbeth Ferdinande
- Department of Diagnostic Sciences, Ghent University, 9000 Ghent, Belgium; (M.V.d.L.); (B.V.G.); (L.R.); (L.F.)
- Department of Pathology, Ghent University Hospital, 9000 Ghent, Belgium
| | | | - Joni Van der Meulen
- Cancer Research Institute Ghent, 9000 Ghent, Belgium; (K.V.); (Y.L.); (J.V.d.M.); (K.C.)
- Center for Medical Genetics, Ghent University Hospital, 9000 Ghent, Belgium;
- Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium
| | - Kathleen Claes
- Cancer Research Institute Ghent, 9000 Ghent, Belgium; (K.V.); (Y.L.); (J.V.d.M.); (K.C.)
- Center for Medical Genetics, Ghent University Hospital, 9000 Ghent, Belgium;
- Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium
| | - Björn Menten
- Center for Medical Genetics, Ghent University Hospital, 9000 Ghent, Belgium;
- Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium
| | - Jo Van Dorpe
- Department of Diagnostic Sciences, Ghent University, 9000 Ghent, Belgium; (M.V.d.L.); (B.V.G.); (L.R.); (L.F.)
- Cancer Research Institute Ghent, 9000 Ghent, Belgium; (K.V.); (Y.L.); (J.V.d.M.); (K.C.)
- Department of Pathology, Ghent University Hospital, 9000 Ghent, Belgium
- Correspondence:
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16
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Augustyniak K, Chrabaszcz K, Smeda M, Stojak M, Marzec KM, Malek K. High-Resolution Fourier Transform Infrared (FT-IR) Spectroscopic Imaging for Detection of Lung Structures and Cancer-Related Abnormalities in a Murine Model. APPLIED SPECTROSCOPY 2022; 76:439-450. [PMID: 34076540 DOI: 10.1177/00037028211025540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Label-free molecular imaging is a promising utility to study tissues in terms of the identification of their compartments as well as chemical features and alterations induced by disease. The aim of this work was to assess if higher magnification of optics in the Fourier transform infrared (FT-IR) microscope coupled with the focal plane detector resulted in better resolution of lung structures and if the histopathological features correlated with clustering of spectral images. FT-IR spectroscopic imaging was performed on paraffinized lung tissue sections from mice with optics providing a total magnification of 61× and 36×. Then, IR images were subjected to unsupervised cluster analysis and, subsequently, cluster maps were compared with hematoxylin and eosin staining of the same tissue section. Based on these results, we observed minute features such as cellular compartments in single alveoli and bronchiole, blood cells and megakaryocytes in a vessel as well as atelectasis of the lung. In the case of the latter, differences in composition were also noted between the tissue from the non-cancerous and cancerous specimen. This study demonstrated the ability of high-definition FT-IR imaging to evaluate the chemical features of well-resolved lung structures that could complement the histological examination widely used in animal models of disease.
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Affiliation(s)
| | | | - Marta Smeda
- Jagiellonian Centre for Experimental Therapeutics (JCET), Jagiellonian University, Krakow, Poland
| | - Marta Stojak
- Jagiellonian Centre for Experimental Therapeutics (JCET), Jagiellonian University, Krakow, Poland
| | - Katarzyna M Marzec
- Jagiellonian Centre for Experimental Therapeutics (JCET), Jagiellonian University, Krakow, Poland
| | - Kamilla Malek
- Faculty of Chemistry, Jagiellonian University, Krakow, Poland
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17
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Cell-Free DNA at Diagnosis for Stage IV Non-Small Cell Lung Cancer: Costs, Time to Diagnosis and Clinical Relevance. Cancers (Basel) 2022; 14:cancers14071783. [PMID: 35406555 PMCID: PMC8997553 DOI: 10.3390/cancers14071783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 02/01/2023] Open
Abstract
Tissue biopsies can be burdensome and are only effective in 10–30% of patients with metastasized non-small-cell lung cancer (mNSCLC). Next-generation sequencing (NGS) on cell-free DNA (cfDNA) might be an attractive alternative. We evaluated the costs, throughput time, and diagnostic yield of two diagnostic scenarios with tissue and cfDNA for mNSCLC patients, compared to diagnostics based on tissue biopsy alone. Data were retrieved from 209 stage IV NSCLC patients included in 10 hospitals in the Netherlands in the observational Lung cancer Early Molecular Assessment (LEMA) trial. Discrete event simulation was developed to compare three scenarios, using LEMA data as input where possible: (1) diagnostics with “tissue only”; (2) diagnostics with “cfDNA first”, and subsequent tissue biopsy if required (negative for EGFR, BRAF ALK, ROS1); (3) cfDNA if tissue biopsy failed (“tissue first”). Scenario- and probabilistic analyses were performed to quantify uncertainty. In scenario 1, 84% (Credibility Interval [CrI] 70–94%) of the cases had a clinically relevant test result, compared to 93% (CrI 86–98%) in scenario 2, and 93% (CrI 86–99%) in scenario 3. The mean throughput time was 20 days (CrI 17–23) pp in scenario 1, 9 days (CrI 7–11) in scenario 2, and 19 days (CrI 16–22) in scenario 3. Mean costs were €2304 pp (CrI €2067–2507) in scenario 1, compared to €3218 (CrI €3071–3396) for scenario 2, and €2448 (CrI €2382–2506) for scenario 3. Scenarios 2 and 3 led to a reduction in tissue biopsies of 16% and 9%, respectively. In this process-based simulation analysis, the implementation of cfDNA for patients with mNSCLC resulted in faster completion of molecular profiling with more identified targets, with marginal extra costs in scenario 3.
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18
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Age as a Risk Factor in the Occurrence of Complications during or after Bronchoscopic Lung Biopsy. Geriatrics (Basel) 2022; 7:geriatrics7020034. [PMID: 35314606 PMCID: PMC8938852 DOI: 10.3390/geriatrics7020034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/13/2022] [Accepted: 03/18/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction: Bronchoscopic lung biopsy (BLB) is a widely used procedure. As the world’s population is ageing, more BLBs are performed for older people with comorbidities. The aim of the study was to investigate if an older age is a risk factor for BLB related complications. Materials and Methods: A prospective study at the Centre of Pulmonology and Allergology of Vilnius University Hospital Santaros klinikos was conducted. Seven hundred and eighty-six patients (male 60.6%), mean age 57 ± 16, who underwent BLB, were included. The complications that occurred due to BLB were evaluated. Bleeding and pneumothorax were classified into I° or II° grades depending on their severity. Potential determinants, which may increase the risk of complications, emphasizing on age, were analyzed. Results: Fifty-seven (7.2%) BLB-related complications occurred. There were 27 (3.4%) pneumothoraxes, and 19 (70%) of them required thoracic drainage. Thirty (3.8%) bleeding complications occurred, and four (16%) of them were severe. Higher rates of bleeding were found in the age group ≥65 years, p = 0.001. The risk of bleeding in older patients was 3.2 times higher (95% CI 1.51–6.87). Conclusions: Older age is related to a higher incidence of mild bleeding during BLB. However, the risk of life-threatening complications is low despite the age, and older age should not be considered as a contraindication for the procedure if needed.
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19
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Cui W, Milner-Watts C, McVeigh TP, Minchom A, Bholse J, Davidson M, Yousaf N, MacMahon S, Mugalaasi H, Gunapala R, Lee R, George A, Popat S, O'Brien M. A pilot of Blood-First diagnostic cell free DNA (cfDNA) next generation sequencing (NGS) in patients with suspected advanced lung cancer. Lung Cancer 2022; 165:34-42. [PMID: 35085982 DOI: 10.1016/j.lungcan.2022.01.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/11/2022] [Accepted: 01/15/2022] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The diagnostic pathway for lung cancer can be long. Availability of front-line targeted therapies for NSCLC demands access to good quality tissue for genomic sequencing and rapid reporting of results. Diagnosis of lung cancer and availability of tissue was delayed during the COVID-19 pandemic. METHODS A pilot study assessing Guardant360™ cfDNA-NGS in patients with radiological-suspected advanced-stage lung cancer was performed at an academic cancer centre during COVID-19. Variants were tiered using AMP/ASCO/CAP guidelines and discussed at a tumour molecular board. The primary endpoint was the proportion of patients who commenced targeted treatment based on cfDNA-NGS results without tissue molecular results, predicted to be ≥ 10%. RESULTS Between April 2020-May 2021, 51 patients were enrolled; 49 were evaluable. The median age was 71 years, 43% were never-smokers, 86% had stage IV disease. 80% of evaluable cfDNA-NGS were informative (tumour-derived cfDNA detected). cfDNA-NGS detected 30 (61%) AMP/ASCO/CAP tier 1 variants, including 20 additional tier 1 variants compared to tissue testing. Three patients with non-informative cfDNA-NGS had tier 1 variants identified on tissue testing. Eleven (22%; 95%CI 12%-27%) patients commenced targeted therapy based on cfDNA-NGS results without tissue molecular results, meeting the primary endpoint. Median time to results was shorter for cfDNA-NGS compared to standard-of-care tissue tests (9 versus 25 days, P < 0.0001). CONCLUSION Blood-first cfDNA-NGS in NSCLC patients increased the breadth and rapidity of detection of actionable variants with high tissue concordance and led to timely treatment decisions. A blood-first approach should be considered to improve the speed and accuracy of therapeutic decision-making.
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Affiliation(s)
- Wanyuan Cui
- Lung Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - Terri P McVeigh
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Anna Minchom
- Lung Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Jaishree Bholse
- Lung Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Michael Davidson
- Lung Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Nadia Yousaf
- Lung Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom; Thoracic Oncology, Institute of Cancer Research, London, United Kingdom
| | - Suzanne MacMahon
- Centre for Molecular Pathology, Royal Marsden NHS Foundation Trust, London, United Kingdom; Cancer Genomics, North Thames Genomic Laboratory Hub, London, United Kingdom
| | - Hood Mugalaasi
- Centre for Molecular Pathology, Royal Marsden NHS Foundation Trust, London, United Kingdom; Division of Molecular Pathology, Institute of Cancer Research, London, United Kingdom
| | - Ranga Gunapala
- Lung Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Richard Lee
- Lung Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom; Early Diagnosis and Detection, NIHR Royal Marsden and ICR Biomedical Research Centre, United Kingdom
| | - Angela George
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom; Gynaecology Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Sanjay Popat
- Lung Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom; Thoracic Oncology, Institute of Cancer Research, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Mary O'Brien
- Lung Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom.
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Zhang Y, Simoff MJ, Ost D, Wagner OJ, Lavin J, Nauman B, Hsieh MC, Wu XC, Pettiford B, Shi L. Understanding the patient journey to diagnosis of lung cancer. BMC Cancer 2021; 21:402. [PMID: 33853552 PMCID: PMC8045203 DOI: 10.1186/s12885-021-08067-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/08/2021] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE This research describes the clinical pathway and characteristics of two cohorts of patients. The first cohort consists of patients with a confirmed diagnosis of lung cancer while the second consists of patients with a solitary pulmonary nodule (SPN) and no evidence of lung cancer. Linked data from an electronic medical record and the Louisiana Tumor Registry were used in this investigation. MATERIALS AND METHODS REACHnet is one of 9 clinical research networks (CRNs) in PCORnet®, the National Patient-Centered Clinical Research Network and includes electronic health records for over 8 million patients from multiple partner health systems. Data from Ochsner Health System and Tulane Medical Center were linked to Louisiana Tumor Registry (LTR), a statewide population-based cancer registry, for analysis of patient's clinical pathways between July 2013 and 2017. Patient characteristics and health services utilization rates by cancer stage were reported as frequency distributions. The Kaplan-Meier product limit method was used to estimate the time from index date to diagnosis by stage in lung cancer cohort. RESULTS A total of 30,559 potentially eligible patients were identified and 2929 (9.58%) had primary lung cancer. Of these, 1496 (51.1%) were documented in LTR and their clinical pathway to diagnosis was further studied. Time to diagnosis varied significantly by cancer stage. A total of 24,140 patients with an SPN were identified in REACHnet and 15,978 (66.6%) had documented follow up care for 1 year. 1612 (10%) had no evidence of any work up for their SPN. The remaining 14,366 had some evidence of follow up, primarily office visits and additional chest imaging. CONCLUSION In both cohorts multiple biopsies were evident in the clinical pathway. Despite clinical workup, 70% of patients in the lung cancer cohort had stage III or IV disease. In the SPN cohort, only 66% were identified as receiving a diagnostic work-up.
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Affiliation(s)
- Yichen Zhang
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1900, New Orleans, LA 70112 USA
| | - Michael J. Simoff
- Bronchoscopy and Interventional Pulmonology, Lung Cancer Screening Program, Pulmonary & Critical Care Medicine, Henry Ford Hospital, Wayne State University School of Medicine, 2799 West Grand Boulevard, Detroit, MI 48202 USA
| | - David Ost
- Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA
| | | | - James Lavin
- Intuitive, 1020 Kifer Road, Sunnyvale, CA 94086 USA
| | - Beth Nauman
- Louisiana Public Health Institute, 1515 Poydras Street #1200, New Orleans, LA 70112 USA
| | - Mei-Chin Hsieh
- Louisiana State University Health Science Center, 433 Bolivar St, New Orleans, LA 70112 USA
| | - Xiao-Cheng Wu
- Louisiana State University Health Science Center, 433 Bolivar St, New Orleans, LA 70112 USA
| | - Brian Pettiford
- Ochsner Health System, 1514 Jefferson Highway, Jefferson, LA 70121 USA
| | - Lizheng Shi
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1900, New Orleans, LA 70112 USA
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21
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Chiu YW, Kao YH, Simoff MJ, Ost DE, Wagner O, Lavin J, Culbertson RA, Smith DG. Costs of Biopsy and Complications in Patients with Lung Cancer. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:191-200. [PMID: 33762834 PMCID: PMC7982449 DOI: 10.2147/ceor.s295494] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/04/2021] [Indexed: 12/26/2022] Open
Abstract
Purpose To describe the distribution of diagnostic procedures, rates of complications, and total cost of biopsies for patients with lung cancer. Patients and Methods Observational study using data from IBM Marketscan® Databases for continuously insured adult patients with a primary lung cancer diagnosis and treatment between July 2013 and June 2017. Costs of lung cancer diagnosis covered 6 months prior to index biopsy through treatment. Costs of chest CT scans, biopsy, and post-procedural complications were estimated from total payments. Costs of biopsies incidental to inpatient admissions were estimated by comparable outpatient biopsies. Results The database included 22,870 patients who had a total of 37,160 biopsies, of which 16,009 (43.1%) were percutaneous, 14,997 (40.4%) bronchoscopic, 4072 (11.0%) surgical and 2082 (5.6%) mediastinoscopic. Multiple biopsies were performed on 41.9% of patients. The most common complications among patients receiving only one type of biopsy were pneumothorax (1304 patients, 8.4%), bleeding (744 patients, 4.8%) and intubation (400 patients, 2.6%). However, most complications did not require interventions that would add to costs. Median total costs were highest for inpatient surgical biopsies ($29,988) and lowest for outpatient percutaneous biopsies ($1028). Repeat biopsies of the same type increased costs by 40–80%. Complications account for 13% of total costs. Conclusion Costs of biopsies to confirm lung cancer diagnosis vary substantially by type of biopsy and setting. Multiple biopsies, inpatient procedures and complications result in higher costs.
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Affiliation(s)
- Yu-Wen Chiu
- Health Policy & Systems Management, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Yu-Hsiang Kao
- Health Policy & Systems Management, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Michael J Simoff
- Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - David E Ost
- Department of Pulmonology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - James Lavin
- Intuitive Surgical, Sunnyvale, California, USA
| | - Richard A Culbertson
- Health Policy & Systems Management, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Dean G Smith
- Health Policy & Systems Management, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
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Bilgin SS, Gultekin MA, Yurtsever I, Yilmaz TF, Cesme DH, Bilgin M, Topcu A, Besiroglu M, Turk HM, Alkan A, Bilgin M. Diffusion Tensor Imaging Can Discriminate the Primary Cell Type of Intracranial Metastases for Patients with Lung Cancer. Magn Reson Med Sci 2021; 21:425-431. [PMID: 33658441 PMCID: PMC9316134 DOI: 10.2463/mrms.mp.2020-0183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Histopathological differentiation of primary lung cancer is clinically important. We aimed to investigate whether diffusion tensor imaging (DTI) parameters of metastatic brain lesions could predict the histopathological types of the primary lung cancer. METHODS In total, 53 patients with 98 solid metastatic brain lesions of lung cancer were included. Lung tumors were subgrouped as non-small cell carcinoma (NSCLC) (n = 34) and small cell carcinoma (SCLC) (n = 19). Apparent diffusion coefficient (ADC) and Fractional anisotropy (FA) values were calculated from solid enhanced part of the brain metastases. The association between FA and ADC values and histopathological subtype of the primary tumor was investigated. RESULTS The mean ADC and FA values obtained from the solid part of the brain metastases of SCLC were significantly lower than the NSCLC metastases (P < 0.001 and P = 0.003, respectively). ROC curve analysis showed diagnostic performance for mean ADC values (AUC=0.889, P = < 0.001) and FA values (AUC = 0.677, P = 0.002). Cut-off value of > 0.909 × 10-3 mm2/s for mean ADC (Sensitivity = 80.3, Specificity = 83.8, PPV = 89.1, NPV = 72.1) and > 0.139 for FA values (Sensitivity = 80.3, Specificity = 54.1, PPV = 74.2, NPV= 62.5) revealed in differentiating NSCLC from NSCLC. CONCLUSION DTI parameters of brain metastasis can discriminate SCLC and NSCLC. ADC and FA values of metastatic brain lesions due to the lung cancer may be an important tool to differentiate histopathological subgroups. DTI may guide clinicians for the management of intracranial metastatic lesions of lung cancer.
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Affiliation(s)
| | | | - Ismail Yurtsever
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University
| | - Temel Fatih Yilmaz
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University
| | - Dilek Hacer Cesme
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University
| | - Melike Bilgin
- Department of Radiology, Faculty of Medicine, Justus Liebig University
| | - Atakan Topcu
- Department of Medical Oncology, Faculty of Medicine, Bezmialem Vakif University
| | - Mehmet Besiroglu
- Department of Medical Oncology, Faculty of Medicine, Bezmialem Vakif University
| | - Haci Mehmet Turk
- Department of Medical Oncology, Faculty of Medicine, Bezmialem Vakif University
| | - Alpay Alkan
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University
| | - Mehmet Bilgin
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University
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