Alda Lui Tam MD, Presenter: Stockholder, General Electric Company Stockholder, Johnson & Johnson Stockholder, Novartis AG

Edward S Kim MD, Abstract Co-Author: Nothing to Disclose

David Stewart MD, Abstract Co-Author: Nothing to Disclose

Roy S. Herbst MD, Abstract Co-Author: Consultant, AstraZeneca PLC Consultant, Amgen Inc Consultant, Genentech, Inc Consultant, Bristol-Myers Squibb Company Research funded, AstraZeneca PLC

Ignacio Wistuba, Abstract Co-Author: Nothing to Disclose

Marshall E. Hicks MD, Abstract Co-Author: Stockholder, Pfizer Inc, New York, NY Stockholder, General Electric Company, Fairfield, CT Stockholder, St. Jude Medical, Inc, St. Paul, MN

Waun K. Hong MD, Abstract Co-Author: Nothing to Disclose

Sanjay Gupta MD, Abstract Co-Author: Nothing to Disclose

00030490-DMT et al, Abstract Co-Author: Nothing to Disclose

Trans-thoracic diagnostic needle biopsies are associated with known risks and complications. Additional tissue is increasingly required for clinical trials focusing on personalized targeted anti-cancer therapy. We report our experience with using small-caliber core needle biopsies for the evaluation of multiple molecular biomarkers during trans-thoracic biopsy.

Following approval by the institutional IRB, the medical records of patients who underwent trans-thoracic biopsy as part of a clinical research trial were reviewed for the following parameters: biopsy site, imaging findings, needle size, image-guidance, diagnostic yield, and procedural complications.

131 trans-thoracic biopsies were performed in 113 patients. These included biopsies from pulmonary (n=106), pleural (n=18), mediastinal (n=5) or hilar (n=2) lesions. Biopsies were performed with CT (n=129) or ultrasound (n=2) guidance. Co-axial technique using an 18-gauge guide needle was used in 98.5% of cases. 20-gauge core biopsy needles were used to obtain tissue samples in 97% of cases. One hundred and five (80.1%) of the biopsy specimens were found to have adequate tumor tissue for analysis of the required biomarkers. Biopsy sites in the 26 patients with inadequate samples were from lung lesions. Histological evaluation of slides suggested that main reasons of failure were extensive tumor necrosis and fibrosis in tissue samples. Review of imaging data in the patients with inadequate tissue samples showed that the tissue yield in 10 of these patients could potentially have been improved by sampling a different lesion, sampling a different portion of the lesion, and performing a PET scan before biopsy to assess for viable tumor. Complications consisting of pneumothorax occurred after 18 biopsy procedures (13.7%). Eleven of these patients (8.4%) required small-bore chest tube placement; most of these patients were managed on an outpatient basis with the tubes removed the next day.  

Image-guided 20-gauge core needle biopsy is safe and provides adequate tissue for analysis of multiple biomarkers in the majority of cases. Careful appraisal of imaging to select the appropriate biopsy site has the potential to improve the diagnostic yield.

Trans-thoracic, small caliber core needle biopsy provides sufficient tissue for analysis of biomarkers in the setting of clinical trials studing targeted cancer therapy.

Tam, A, Kim, E, Stewart, D, Herbst, R, Wistuba, I, Hicks, M, Hong, W, Gupta, S, et al, 0, Safety and Adequacy of Image-guided Small Caliber Core Needle Transthoracic Biopsies for Evaluation of Multiple Molecular Biomarkers in Clinical Trials.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8013486.html