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目的对于先前化疗耐受的非小细胞肺癌病人,评价为突变分析而进行重复活检的可行性和安全性。材料与方法这项前瞻性研究获得单位伦理委员会批准,并取得所有病人的知情同意书。选择126例对常规化疗或表皮生长因子受体(EGFR)-酪氨酸激酶抑制剂耐受的非小细胞肺癌病人,对其中94例病人[男31例,女63例,(57±10.3)岁]进行重复活检。32例病人在严格观察胸部CT影像后因各种原因被排除。采用C臂锥形束CT导向进行经皮胸穿肺活检。评价重复活检的技术成功率和进行突变分析的标本充足率。记录任何与活检相关的并发症。结果活检的技术成功率为100%。94例病人中的75例(80%)标本已足以进行突变分析。75例标本中,35例进行了EGFR突变检测,34例进行了间变性淋巴瘤激酶(ALK)基因重组检测,6例两者都进行。结果显示,20例EGFR光敏突变(外显子19或21)为阳性,5例出现EGFRT790M突变,而11例发现间变性淋巴瘤激酶基因重组。94例病人中13例(14%)出现术后并发症。结论当采用严格的CT标准进行操作时,对先前进行化疗的非小细胞肺癌病人进行突变分析时,重复活检是可行的,大约4/5的病人样品足够进行基因分析,而并发症的发生率可以接受。
Objective To evaluate the feasibility and safety of repeat biopsy for mutation analysis in patients with previously non-small cell lung cancer who are refractory to chemotherapy. Materials and Methods This prospective study was approved by the ethics committee and obtained informed consent from all patients. A total of 126 patients with non-small cell lung cancer who were resistant to conventional chemotherapy or epidermal growth factor receptor (EGFR) -type tyrosine kinase inhibitors were enrolled in this study, including 94 males [31 males and 63 females (57 ± 10.3) Year old] for repeat biopsy. Thirty-two patients were excluded due to various reasons after a rigorous observation of chest CT images. C-arm cone beam CT guided percutaneous thoracic lung biopsy. Evaluate the technical success rate of repeat biopsy and the sample adequacy of the mutation analysis. Record any biopsy-related complications. Results The technical success rate of biopsy was 100%. Seventy-five (80%) of the 94 patients were sufficient for mutation analysis. Of the 75 specimens, 35 had EGFR mutation detection, 34 had an ALT gene reassignment, and 6 had both. The results showed that 20 cases of EGFR photosensitivity mutation (exon 19 or 21) was positive, EGFRT790M mutation occurred in 5 cases, and found in 11 cases of anaplastic lymphoma kinase gene recombination. Postoperative complications occurred in 13 of 94 patients (14%). Conclusions Duplicate biopsy is feasible when using rigorous CT standards for mutation analysis of previously chemotherapy-naive patients with non-small cell lung cancer. Approximately four out of five patient samples are sufficient for genetic analysis and the incidence of complications acceptable.