CT导向肺癌穿刺标本表皮生长因子受体基因突变检测的应用价值

Determination of epidermal growth factor receptor gene mutation of lung cancer specimen obtained by CT-guided transthoracic needle aspiration:its clinical value

目的评价应用CT导向肺癌穿刺活检标本检测表皮生长因子受体(EGFR)基因突变的价值。方法 21例穿刺前未接受肿瘤治疗,无其他肿瘤病史,临床诊断Ⅲ～Ⅳ期期肺癌病例。采用多排螺旋CT导向作病灶活检,所有标本均作病理学检查并采用PCR法检测EGFR突变。结果①21例中9例使用18 G Chiba针,12例用20 G Chiba针。病理诊断为腺癌12例、鳞癌3例、小细胞癌1例、未分化癌5例。②21例穿刺术后3例见针道少量渗血,无一例出现气胸。③21例标本中,共检测到EGFR突变10例(47.6%)。12例腺癌患者中8例检出EGFR突变,其他类型肿瘤2例突变;在12例女性患者中有8例发现EGFR体突变,9例男性患者有2例突变。结论活检标本中EGFR基因突变可为临床药物分子靶向治疗提供依据。

Objective To evaluate CT-guided transthoracic needle biopsy specimens in assessing epidermal growth factor receptor（EGFR）gene mutation in lung cancer.Methods Twenty-one patients（9 males and 12 females,with a mean age of 62 years） with advanced lung cancer were enrolled in this study.Before treatment all patients underwent CT-guided transthoracic needle biopsy of the lung tumor.The biopsy specimens were sent for histopathological study and EGFR gene mutation was determined with PCR method.A 18-gauge needle or 20-gauge needle was used for the procedures.The results were analyzed.Results The mean largest diameter of the lung masses was 4.5 cm（ranged from 1.5 cm to 13 cm） on CT scans.The 18-gauge puncturing needle was used in 9 cases and the 20-gauge puncturing needle was used in 12 cases.Histological diagnoses included adenocarcinoma（n = 12）,squamous cell carcinoma（n = 3）,poorly differentiated carcinomas（n = 5） and small cell lung cancer（n = 1）.EGFR mutations were detected in 10 of the 21 lung tumors（47.6%）.Of 12 adenocarcinoma lesions,EGFR gene mutations were detected in 8.Among 12 females patients,EGFR gene mutations were seen in 8.Conclusion The presence of Egfr gene mutation detected in biopsy specimens provides laboratory basis for the clinical targeted therapy with drug molecules.