Comparison between cryobiopsy and forceps biopsy in detection of epidermal growth factor receptor amplification in non-small-cell lung cancer



Ahmed S.H Mohamed1, Mohamed Hantera1, Ragia S Sharshar1, Amira Y Abdelnaby2, Ayman El Saka3

1 Departments of Chest, Tanta University, Tanta, Egypt

2 Departments of Clinical Pathology, Tanta University, Tanta, Egypt

3 Departments of Pathology, Faculty of Medicine, Tanta University, Tanta, Egypt



Correspondence Address:

MD Ragia S Sharshar

Chest Department, Faculty of Medicine, Tanta University, Tanta, 1221

Egypt

Source of Support: None, Conflict of Interest: None Check

DOI: 10.4103/ejb.ejb_40_19



Background Non-small-cell lung cancer (NSCLC) represents 85% of lung cancer cases. Genotyping is now considered as a cornerstone in proper management and better results of such cancers, especially with targeted therapy. Cryobiopsy is a promising tool in NSCLC to obtain larger samples, with well-preserved tissue sufficient for accurate histopathological and gene detection.

Aim To compare cryobiopsy and ordinary forceps results in detection of epidermal growth factor receptor (EGFR) amplification in NSCLC.

Materials and methods Samples from 34 patients with proven NSCLC by cryobiopsy versus forceps biopsy were compared for size, quality, and diagnostic yield of EGFR gene amplification.

Results The samples obtained by cryoprobe had larger size and better artifact-free areas with more diagnostic yield of EGFR gene amplification (29.4%) versus with forceps biopsy (8.8%), with gene amplification showing higher statistical significance in younger patients, never smokers, and women (P<0.001).

Conclusion Cryobiopsy is an excellent tool for larger, better-quality sampling and for higher diagnostic yield of EGFR amplification in NSCLC.

Keywords: cryobiopsy epidermal growth factor receptor, cryobiopsy, EGFR, non-small-cell lung cancer

1. Clin Lung Cancer 2014; 15:398–404.

Slavik T, Asselah F, Fakhruddin N. Diagnosis and predictive molecular analysis of non-small-cell lung cancer in the Africa-Middle East region: challenges and strategies for improvement.2014;:398–404.

2. Curr Oncol 2012; 19:S16–S23.

Ofiara LM, Navasakulpong A, Ezer N, Gonzalez AV. The importance of a satisfactory biopsy for the diagnosis of lung cancer in the era of personalized treatment.2012;:S16–S23.

3. Mol Clin Oncol 2016; 4:119–125.

Jeyabalan A, Bhatt N, Plummeridge MJ, Medford RL. Adequacy of endobronchial ultrasound-guided transbronchial needle aspiration samples processed as histopathological samples for genetic mutation analysis in lung adenocarcinoma.2016;:119–125.

4. et al. Cryobiopsy increases the diagnostic yield of endobronchial biopsy: a multicenter trial. Eur Respir J 2012; 39:685–690.

Hetzel J, Eberhardt R, Herth FJ, Petermann C, Reichle G, Freitag LCryobiopsy increases the diagnostic yield of endobronchial biopsy: a multicenter trial.2012;:685–690.

5. Egypt J Chest Dis Tuberc 2015; 65:267–270.

Mohamed AS, Sharshar RS, Wasfy RE. The diagnostic yield of cryobiopsy versus forceps biopsy of malignant endobronchial lesions.2015;:267–270.

6. J Thorac Cardiovasc Surg 2004; 127:1427–1431.

Hetzel M, Hetzel J, Schumann C, Marx N, Babiak A. Cryorecanalization: a new approach for immediate management of acute airway obstruction.2004;:1427–1431.

7. et al. Cryoprobe biopsy increases the diagnostic yield in endobronchial tumor lesions. J Thorac Cardiovasc Surg 2010; 140:417–421.

Schumann C, Hetzel J, Babiak AJ, Merk T, Wibmer T, Moller PCryoprobe biopsy increases the diagnostic yield in endobronchial tumor lesions.2010;:417–421.

8. et al. British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults: accredited by NICE. Thorax 2013; 68:i1–i44.

Du Rand IA, Blaikley J, Booton R, Chaudhuri N, Gupta V, Khalid SBritish Thoracic Society guideline for diagnostic flexible bronchoscopy in adults: accredited by NICE.2013;:i1–i44.

9. Histochem Cell Biol 1997; 108:381–390.

Werner M, Wilkens L, Aubele M, Nolte M, Zitzelsberger H, Komminoth P. Interphase cytogenetics in pathology: principles, methods, and applications of fluorescence in situ hybridization (FISH).1997;:381–390.

10. et al. Epidermal growth factor receptor gene and protein and gefitinib sensitivity in non-small-cell lung cancer. J Natl Cancer Inst 2005; 97:643–655.

Cappuzzo F, Hirsch FR, Rossi E, Bartolini S, Ceresoli GL, Bemis LEpidermal growth factor receptor gene and protein and gefitinib sensitivity in non-small-cell lung cancer.2005;:643–655.

11. et al. EGFR fluorescence in situ hybridisation assay: guidelines for application to non-small-cell lung cancer. J Clin Pathol 2009; 62:970–977.

Varella-Garcia M, Diebold J, Eberhard DA, Geenen K, Hirschmann A, Kockx MEGFR fluorescence in situ hybridisation assay: guidelines for application to non-small-cell lung cancer.2009;:970–977.

12. Clin Chest Med 2002; 23:137–158.

Mazzone P, Jain P, Arroliga AC, Matthay RA. Bronchoscopy and needle biopsy techniques for diagnosis and staging of lung cancer.2002;:137–158.

13. et al. Diagnosis of lung cancer in small biopsies and cytology: implications of the 2011 International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification. Arch Pathol Lab Med 2013; 137:668–684.

Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger K, Yatabe YDiagnosis of lung cancer in small biopsies and cytology: implications of the 2011 International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification.2013;:668–684.

14. et al. The challenge of NSCLC diagnosis and predictive analysis on small samples.Practical approach of a working group. Lung Cancer 2012; 76:1–18.

Thunnissen E, Kerr KM, Herth FJ, Lantuejoul S, Papotti M, Rintoul RCThe challenge of NSCLC diagnosis and predictive analysis on small samples.2012;:1–18.

15. et al. Endobronchial cryobiopsy or forceps biopsy for lung cancer diagnosis. Ann Thorac Med 2010; 5:242–246.

Aktas Z, Gunay E, Hoca NT, Yilmaz A, Demirag F, Gunay SEndobronchial cryobiopsy or forceps biopsy for lung cancer diagnosis.2010;:242–246.

16. Old meets modern: the use of traditional cryoprobes in the age of molecular biology. Respiration 2008; 76:193–197.

Hetzel J, Hetzel M, Hasel C, Moeller P, Babiak A.2008;:193–197.

17. et al. Role of flexible bronchoscopic cryotechnology in diagnosing endobronchial masses. Ann Thorac Surg 2013; 95:982–986.

Chou CL, Wang CW, Lin SM, Fang YF, Yu CT, Chen HCRole of flexible bronchoscopic cryotechnology in diagnosing endobronchial masses.2013;:982–986.

18. Biomed Res Int 2013; 2013:730574.

Rubio ER, Le SR, Whatley RE, Boyd MB. Cryobiopsy: should this be used in place of endobronchial forceps biopsies?2013;:730574.

19. et al. Refining diagnosis and EGFR status of NSCLC in biopsy and cytologic material, using panel of mucin staining, TTF-1, cytokeratin 5/6, P63, and EGFR mutation analysis. J Thorac Oncol 2010; 5:436–441.

Nicholson AG, Gonzalez D, Shah P, Pynegar MJ, Deshmukh M, Rice ARefining diagnosis and EGFR status of NSCLC in biopsy and cytologic material, using panel of mucin staining, TTF-1, cytokeratin 5/6, P63, and EGFR mutation analysis.2010;:436–441.

20. et al. Predictors gefitinib outcomes in advanced non-small cell lung cancer (NSCLC): study of comprehensive panel of molecular markers. Lung Cancer 2010; 67:355–360.

Tiseo M, Rossi G, Capelletti M, Sartori G, Spiritelli E, Marchioni APredictors gefitinib outcomes in advanced non-small cell lung cancer (NSCLC): study of comprehensive panel of molecular markers.2010;:355–360.

21. Adv Respir Med 2017; 85:301–306.

Ehab A, El-Badrawy MK, Moawad AA, Abo-Shehata ME. Cryobiopsy versus forceps biopsy in endobronchial lesions, diagnostic yield and safety.2017;:301–306.

22. et al. Transbronchial cryobiopsy: a new tool for lung biopsies. Respiration 2009; 78:203–208.

Babiak A, Hetzel J, Krishna G, Fritz P, Moeller P, Balli TTransbronchial cryobiopsy: a new tool for lung biopsies.2009;:203–208.

23. Lung 2009; 187:253–259.

Franke KJ, Szyrach M, Nilius G, Hetzel J, Hetzel M, Ruehle KH. Experimental study on biopsy sampling using new flexible cryoprobes: influence of activation time, probe size, tissue consistency, and contact pressure of probe on size of biopsy specimen.2009;:253–259.

24. Surg Endosc 2017; 31:1219–1224.

Segmen F, Aktas Z, Özturk A, Kizilgöz D, Yilmaz A, Alici IO. How many samples would be optimal for endobronchial cryobiopsy?2017;:1219–1224.

25. Pneumologia 2012; 61:230–233.

Jabari H, Sami R, Fakhri M, Kiani A. Different protocols for cryobiopsy versus forceps biopsy in diagnosis of patients with endobronchial tumors.2012;:230–233.

26. Egypt J Chest Dis Tuberc 2015; 65:325–331.

El-Dahdouh S, AbdElaal G, El-kady N. Comparison between endobronchial forceps-biopsy and cryo-biopsy by flexible bronchoscopy.2015;:325–331.

27. Eur J Cancer 2001; 37:S9–S15.

Nicholson RI, Gee JM, Harper ME. EGFR and cancer prognosis.2001;:S9–S15.

28. et al. Correlation of EGFR expression, gene copy number and clinicopathological status in NSCLC. Diagn Pathol 2014; 9:165.

Gaber R, Watermann I, Kugler C, Reinmuth N, Huber RM, Schnabel PACorrelation of EGFR expression, gene copy number and clinicopathological status in NSCLC.2014;:165.

29. et al. Increased EGFR gene copy number detected by fluorescence in situ hybridization is associated with increased sensitivity to gefitinib in patients with bronchioloalveolar carcinoma subtypes.A Southwest Oncology Group study. J Clin Oncol 2005; 23:6838–6845.

Hirsch FR, Varella-Garcia M, McCoy J, West H, Xavier AC, Gumerlock PIncreased EGFR gene copy number detected by fluorescence in situ hybridization is associated with increased sensitivity to gefitinib in patients with bronchioloalveolar carcinoma subtypes.2005;:6838–6845.

30. et al. Epidermal growth factor receptor gene mutations and increased gene copy numbers predict gefitinib sensitivity in patients with recurrent non-small-cell lung cancer. J Clin Oncol 2005; 23:6829–6837.

Takano T, Ohe Y, Sakamoto H, Tsuta K, Matsuno Y, Tateishi UEpidermal growth factor receptor gene mutations and increased gene copy numbers predict gefitinib sensitivity in patients with recurrent non-small-cell lung cancer.2005;:6829–6837.

31. et al. Significance of EGFR protein expression and gene amplification in NSCLC. Am J Clin Pathol 2006; 125:860–865.

Dacic S, Flanagan M, Cieply K, Ramalingam S, Luketich J, Belani CSignificance of EGFR protein expression and gene amplification in NSCLC.2006;:860–865.

32. et al. Epidermal growth factor receptor mutations and gene amplification in non-small-cell lung cancer: molecular analysis of the IDEAL/INTACT gefitinib trials. J Clin Oncol 2005; 23:8081–8092.

Bell DW, Lynch TJ, Haserlat SM, Harris PL, Okimoto RA, Brannigan BWEpidermal growth factor receptor mutations and gene amplification in non-small-cell lung cancer: molecular analysis of the IDEAL/INTACT gefitinib trials.2005;:8081–8092.

33. et al. Molecular predictors of outcome with gefitinib in a phase III placebo-controlled study in advanced non-small-cell lung cancer. J Clin Oncol 2006; 24:5034–5042.

Hirsch FR, Varella-Garcia M, Bunn PAJr, Franklin WA, Dziadziuszko R, Thatcher NMolecular predictors of outcome with gefitinib in a phase III placebo-controlled study in advanced non-small-cell lung cancer.2006;:5034–5042.

34. et al. Comparative analysis of epidermal growth factor receptor mutations and gene amplification as predictors of gefitinib efficacy in Japanese patients with non-small-cell lung cancer. Cancer 2007; 109:1836–1844.

Sone T, Kasahara K, Kimura H, Nishio K, Mizuguchi M, Nakatsumi YComparative analysis of epidermal growth factor receptor mutations and gene amplification as predictors of gefitinib efficacy in Japanese patients with non-small-cell lung cancer.2007;:1836–1844.

35. et al. The impact of epidermal growth factor receptor gene status on gefitinib-treated Japanese patients with non-small-cell lung cancer. Int J Cancer 2007; 120:1239–1247.

Ichihara S, Toyooka S, Fujiwara Y, Hotta K, Shigematsu H, Tokumo MThe impact of epidermal growth factor receptor gene status on gefitinib-treated Japanese patients with non-small-cell lung cancer.2007;:1239–1247.

36. et al. Protein overexpression and gene amplification of epidermal growth factor receptor in NSCLC: comparison of four commercially available antibodies by immunohistochemistry and fluorescence in situ hybridization study. Lung Cancer 2010; 68:375–382.

Lee HJ, Xu X, Choe G, Chung DH, Seo JW, Lee JHProtein overexpression and gene amplification of epidermal growth factor receptor in NSCLC: comparison of four commercially available antibodies by immunohistochemistry and fluorescence in situ hybridization study.2010;:375–382.

37. et al. Epidermal growth factor receptor high gene copy number and activating mutations in lung adenocarcinomas are not consistently accompanied by positivity for EGFR protein by standard immunohistochemistry. J Mol Diagn 2008; 10:160–168.

Pinter F, Papay J, Almasi A, Sapi Z, Szabo E, Kanya MEpidermal growth factor receptor high gene copy number and activating mutations in lung adenocarcinomas are not consistently accompanied by positivity for EGFR protein by standard immunohistochemistry.2008;:160–168.