Adequacy of peripheral lymph nodes specimens for proper lung cancer (LC) characterization
M. Marc Malovrh*a (Dr), J. šrajnerb (Mr), A. Rozmanc (Dr)
a University clinic Golnik, Golnik, Slovenia, SLOVENIA ; b Medical Faculty Ljubljana, Ljubljana, SLOVENIA ; c University clinic Golnik, Golnik, SLOVENIA
* mateja.marc@klinika-golnik.si
Background. In patients with metastatic LC obtaining accurate specimen for full cancer characterization is crucial for optimal choice of systemic treatment. Our aim was to find out how sufficient were easily accessible peripheral lymph node (PLN) specimens in providing the diagnosis and predictive biomarkers testing.
Methods. We retrospectively analysed 85 patients with LC who had PLN puncture (with or without ultrasound -US guidance) as the first invasive diagnostic procedure in three year period at University Clinic Golnik (2018-2021). In 32 patients puncture of palpable PLN without US guidance, and in 53 patients US guided PLN puncture was performed (in 27 of them with cytological and in 26 with histological needle). The decision when the predictive tests were performed was accepted according to the current guidelines. Among mutations, EGFR and KRAS were tested first (PCR), if both negative, tests for ALK (IHC), and in case of negative ALK test, NTRK, ROS1 (FISH) or BRAF (PCR) followed.
Results. Samples obtained by palpable PLN puncture provided adequate material for treatment decision in 50% cases, molecular tests were possible for PDL1 in 48%, EGFR and KRAS in 52.1%, ALK in 38.9% and ROS1, NTRK, BRAF in 33.3%. US guided PLN puncture by cytological needle was sufficient for treatment decision in 70.4% of patients, for PDL1 in 63.6%, EGFR, KRAS in 61.1%, ALK, ROS1, NTRK, BRAF tests in 33.3%. US PLN puncture by histological needle was sufficient for treatment decision in 57.7% of patients, for PLD1 in 50%, for EGFR, KRAS in 52.9%, ALK, ROS1 in 42.9%, NTRK and BRAF tests in 30%. No complications due to PLN puncture were reported.
Conclusions. Metastatic PLN puncture provided sufficient material for treatment decision in more then half of patients. Our results further show superiority of cytological puncture with US guidence compared to the other two techniques.
Disclosure of funding source(s): none