Application Research Of EBUS-TBNA In The Diagnosis Of Lung Cancer And EGFR Gene Mutation Detection

Background:Primary bronchogenic carcinoma(lung cancer) have originated in the bronchial mucosa malignant tumor, Among the top of the global cancer mortality.The most patients are diagnosed at the advanced stage. The chemotherapy and molecular targeted therapy are the main treatment for lung cancer. But specific chemotherapy regimens can be selected to depends on histopathological types of lung cancer. So, how to acquire in the case of non-surgical lung cancer tissue samples for pathological diagnosis and molecular target detection has important significance.The molecular targeting treatment of epidermal growth factor receptor(EGFR) obtains satisfactory therapeutic effect in clinical trials on advanced non-small cell lung carcinoma(NSCLC) treatment. It could greatly improve the quality of the patient’s life and prolong the survival period of patients. At present,detection methods are mainly surgical specimens of direct sequencing method, but,It have demand the most DNA content of specimen, and the most patients would’t have the chance to surgery, they need to rely on non-surgical specimen to test. Now, the mainly methods obtained the small biopsy specimens of lung cancer include bronchoscopy biopsy, conventional TBNA and EBUS-TBNA etc. EBUS-TBNA is the emerging technology,at present. the pathology specimen of mediastinal lymph node and lung lesions have obtained in real-time ultrasound guided by bronchoscopy, It was mainly used for the diagnosis and staging of lung cancer.Evaluating the small biopsy specimens of lung cancer in the role of EGFR gene detection,and improving the small biopsy specimens of lung cancer diagnosis,and detecting rate of EGFR gene,that are becoming a hot spot of clinical research. Objective:To explore the value of EBUS-TBNA in the diagnosis of lung cancer, Detecting and analyzing of EGFR gene mutation on the EBUS-TBNA biopsy specimens,that can guide the further clinical individual therapy. Methods:This study selected 120 patients in the department of respiratory of the first hospital affiliated to Suzhou University from January 2012 to December 2014.Whose chest CT shows the pulmonary nodules or mass in peripheral bronchial lumen,with / without lymphadenectasis in mediastinal / hilum of lung. Among which 68 cases were male, 52 cases were female,whose age from 36 to 83 years, the median age 58 years, Among which 67 patients were examined by EBUS-TBNA, 20 patients were combined examination of EBUS-TBNA,brush and bronchoalveolar lavage; 40 patients were examined by conventional TBNA,and 7 patients of without definite diagnosis examined by conventional TBNA,who again examined by EBUS-TBNA.And collect with hydrothorax specimens of 52 cases of patients with non-small cell lung cancer with hydrothorax specimens and the small biopsies specimens of 52 cases of patients with non-small cell lung cancer with bronchoscopy biopsy at the same period.The lung cancer diagnosis were analyzed to different methods of obtainsed specimen from tracheoscopy.The biopsy specimens of 67 patients from EBUS-TBNA were detected EGFR gene mutation by using the ARMS.Whose mutation rate were analyzed among different clinical pathological features, and compared the different biopsy specimens to come from hydrothorax, bronchial biopsies and EBUS-TBNA. Results:1. 67 patients in the study, the EBUS-TBNA make a definite diagnosis with 60 cases of lung cancer, it showed a positive rate in 89.55%(60/67); It showed sensitivity, respectively; and accuracy rate in 96.77%(60/62), 100%(5/5)and 97.01%(65/67),respectively; Positive predictive value and negative predictive value were 100%(60/60) and 71.43%(5/7),respectively.2. The positive rate of lung cancer for EBUS-TBNA was much higher than conventional TBNA(67.50%), brush(10.00%) and bronchoalveolar lavage(5.00%), respectively; Results According to statistic analysis, the differences have statistically significant,between EBUS-TBNA and conventional TBNA(X2=8.01,P<0.01), between EBUS-TBNA and brush(X2=47.60,P<0.01), between EBUS-TBNA and bronchoalveolar lavage(X2=52.55,P<0.01). 7 patients of without definite diagnosis examined by conventional TBNA,who again examined by EBUS-TBNA, 5 cases have maked a definite diagnosis of lung cancer. The positive rate is 71.43%(5/7).3. 67 patients in the study, They are tolerated and accepted EBUS-TBNA examine successfully, they have not been found serious complications such as infection, serious hemoptysis and pneumothorax after examine. Only 3 patients have a little bleeding or blood in the sputum on site of puncture, that have not been to give special treatment, and stop bleeding itself.4. In 67 patients with EBUS-TBNA, In addition to the 2 cases with false negative, EGFR gene mutation are 17 cases(28.33%,17/60),which were NSCLC(34.69%,17/49)。The pathological types of lung adenocarcinoma are 13 cases(48.15%,13/27)and squamous carcinoma are 4 cases(18.18%,4/22), 9 cases SCLC, 2 cases with no giving the type of lung cancer have not EGFR gene mutation. In the hydrothorax specimens sediment after centrifugal of 52 cases of patients with NSCLC with hydrothorax( 23 cases of squamous carcinoma,29 cases of adenocarcinoma),EGFR gene mutation are 9 cases(17.31%,9/52),The pathological types of lung adenocarcinoma are 6 cases(20.69%,6/29)and squamous carcinoma are 3 cases(13.04%,3/23).The small biopsies specimens of 52 cases of patients with non-small cell lung cancer with bronchoscopy biopsy( 20 cases of squamous carcinoma,32 cases of adenocarcinoma),EGFR gene mutation are 10 cases(19.23%,10/52),The pathological types of lung adenocarcinoma are 7 cases(21.87%,7/32)and squamous carcinoma are 3 cases(15.00%,3/20).5. EGFR gene mutation rate is 34.69%(17/49)in the biopsy specimens of NSCLC with EBUS-TBNA, higher than 17.31%(9/52)in hydrothorax, the differences have statistically significant(X2=3.99,P<0.05); higher than 19.23%(10/52)in bronchial biopsies, the differences have not statistically significant(X2=1.96,P﹥0.05). Conclusions:1. The EBUS-TBNA has the very high positive rate of diagnosis in peripheral lung cancer with mediastinal lymph node enlargement, even it was much higher than brush, bronchoalveolar lavage and conventional TBNA, respectively. And jointed them can improve the diagnostic positive rate of patients with lung cancer. It can provide the patients with fine specimens of pathology, who has hilum of lung and mediastinal lymphadenectasis of unknown etiology,It is a very effective technology to examine.2.The patients of without definite diagnosis were examined by conventional TBNA, who again examined by EBUS-TBNA, It can improve the positive rate of diagnosis.3. In the 3 small biopsies specimens of EBUS-TBNA, hydrothorax, bronchoscopy biopsy, EGFR gene mutation rate respectively are 34.69%,17.31%,19.23%.In a word, EGFR gene mutation detection is feasible to the biopsy specimens of the patients with EBUS-TBNA,Which has important guiding significance to the individualized treatment in patients with the advanced lung cancer.