Background: The thoracic small biopsy sampling procedure including transbronchial forceps lung biopsy (TBLB) and endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) can be accompanied by rapid on-site evaluation (ROSE) of sample material to provide immediate feedback for the proceduralist. The present study aims to investigate the supplemental effect of ROSE smear samples for lung cancer molecular test.
Methods: In a retrospective study, 308 patients admitted to our hospital from August 2020 to December 2022 undergoing diagnostic TBLB and EBUS-TBNA with ROSE and subsequently diagnosed as non-small cell lung cancer (NSCLC) were analyzed. The matched formalin-fixed paraffin-embedding (FFPE) tissue section and ROSE smears for tumor cellularity were compared. DNA yields of smears were determined. Real-time polymerase chain reaction (PCR) and next-generation sequencing (NGS) were performed on adequate smear samples.
Results: ROSE smear samples were enriched in tumor cells. Among 308 biopsy samples, 78 cases (25.3%) exhibited inadequate FFPE tissue sections, whereas 44 cases (14.3%) yielded adequate smear samples. Somatic mutations detected in the FFPE tissue section samples were also detected in the matching adequate smear sample.
Conclusions: ROSE smear samples of the thoracic small biopsies are beneficial supplemental materials for ancillary testing of lung cancer. Combined use of cytology smear samples with traditional FFPE section samples can enhance the detection rate of informative mutations in patients with advanced NSCLC. We recommend that the laboratory could further evaluate the ROSE cell smears of the patient when FFPE tissue sections are inadequate, and that adequate cell smears can be used as a supplemental source for the molecular testing of NSCLC.
【中文题目：快速现场评估的细胞学涂片对非小细胞肺癌 分子检测的补充作用】 【中文摘要：背景与目的 胸部小活检标本取材包括经支气管镜肺活检术（transbronchial forceps lung biopsy, TBLB）以及超声内镜引导下的经支气管针吸活检（endobronchial ultrasound transbronchial needle aspiration, EBUS-TBNA）可采用术中快速现场评估（rapid on-site evaluation, ROSE）细胞学涂片为操作者迅速给出初步诊断。本研究旨在分析ROSE细胞学涂片对非小细胞肺癌（non-small cell lung cancer, NSCLC）分子检测的补充作用。方法 回顾性分析2020年8月至2022年12月我院收治的308例TBLB及EBUS-TBNA活检并行术中ROSE、病理诊断为NSCLC的病例，评估分析了配对的石蜡切片及ROSE细胞学涂片的肿瘤细胞量和比例，提取细胞学涂片的DNA并定量，部分合格的细胞学涂片标本用于实时定量聚合酶链式反应（polymerase chain reaction, PCR）和第二代测序（next-generation sequencing, NGS）检测。结果 大部分ROSE细胞学涂片均具有丰富的肿瘤细胞，78例（25.3%）石蜡切片分子检测不合格的病例中有44例（14.3%）具有分子检测合格的细胞涂片。石蜡切片检测到的细胞突变均可在合格的细胞学涂片标本中检测到。结论 胸部小活检标本的ROSE细胞学涂片标本对NSCLC的分子检测有很好的补充作用，细胞学涂片与传统的石蜡切片联合应用能促进晚期NSCLC患者靶向治疗驱动基因的检测。建议实验室在评估石蜡切片分子检测不合格时，可进一步评估患者的ROSE细胞学涂片，合格的细胞学涂片可作为NSCLC分子检测的补充标本。 】 【中文关键词：肺肿瘤；活检；快速现场细胞学评估；分子检测】.
Keywords: Biopsy; Lung neoplasms; Molecular testing; Rapid on-site evaluation.