Brief Report|Articles in Press, 100497

Biopsy Method and Needle Size on Success of Next-Generation Sequencing in Non-Small Cell Lung Cancer: A Brief Report

Open AccessPublished:March 10, 2023DOI:
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      Next generation sequencing (NGS) is essential to the care of patients with non-small cell lung cancer (NSCLC). However, NGS is dependent on adequate material from biopsy. We evaluated the impact of biopsy method and needle gauge necessary for optimizing success in tissue NGS.


      A total of 1660 formalin-fixed paraffin-embedded samples were submitted to Caris Life Sciences from 2007-2022 for tumor profiling. The results of NGS assays were linked with retrospective biopsy data for lung cancer patients treated at USC/Norris Cancer Center to create a database with the following parameters: demographics, biopsy method, tumor location (lung mass vs lymph node vs metastasis), needle gauge, number of needle passes, complications, tumor volume, DNA content, and status of NGS. Fisher’s exact test and ANOVA analysis were performed to determine the impact of biopsy method and needle gauge (G).


      77 CT-guided transthoracic core needle biopsies (CT-TTCN), 74 endobronchial ultrasound (EBUS)-guided transbronchial needle aspirations (TBNA), 27 bronchial forceps biopsies, and 107 surgical resections were included. 41 of 77 CT-TTCN biopsies (53.2%), 43 of 74 EBUS-TBNAs (58.1%), 22 of 27 bronchial forceps biopsies (81.5%), and 105 of 107 surgical resections (98.1%) underwent successful NGS assays. The probability of successful NGS completion for lung cancers was highest in surgical resections and bronchial forceps biopsies. Needle based biopsies were more successful when a needle larger than 20G was used. Complication rates were higher for CT-TTCN biopsies compared to EBUS-TBNA (p<0.0001). Overall, the DNA yield was significantly higher in EBUS-TBNA compared to CT-TTCN biopsies in primary lung sites (p = 0.0002). EBUS-TBNA demonstrated higher success rates in NGS compared to CT-TTCN for both primary lung lesions (p= 0.023) and lymph node targets (p=0.035).


      The less invasive EBUS-TBNAs demonstrated higher success rates in NGS than CT-TTCN biopsies and resulted in higher DNA concentrations. In CT-TTCN biopsies, use of 20G or smaller needles is associated with a higher risk of obtaining an inadequate specimen regardless of the number of passes taken. Surgical and bronchial forceps biopsies had highest success in achieving NGS.

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