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Qualitative Computed Tomographic Features Predict Epidermal Growth Factor Receptor Mutations in Advanced Lung Adenocarcinoma

Introduction: Current guidelines recommend reflex testing for EGFR mutations in patients with advanced lung adenocarcinoma. Although tissue biopsy is considered the “gold standard” for EGFR mutation testing, it may not always be feasible in a small group of patients. Hence, this study aims to deter...

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Main Author: Chai, Chee Shee
Format: Article
Language:English
Published: Elsevier 2021
Subjects:
R Medicine (General)
RC Internal medicine
RC0254 Neoplasms. Tumors. Oncology (including Cancer)
Online Access:http://ir.unimas.my/id/eprint/34903/1/abstract.pdf
http://ir.unimas.my/id/eprint/34903/
https://doi.org/10.1016/j.jtho.2021.01.1005
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spelling my.unimas.ir.349032021-03-23T00:47:34Z http://ir.unimas.my/id/eprint/34903/ Qualitative Computed Tomographic Features Predict Epidermal Growth Factor Receptor Mutations in Advanced Lung Adenocarcinoma Chai, Chee Shee R Medicine (General) RC Internal medicine RC0254 Neoplasms. Tumors. Oncology (including Cancer) Introduction: Current guidelines recommend reflex testing for EGFR mutations in patients with advanced lung adenocarcinoma. Although tissue biopsy is considered the “gold standard” for EGFR mutation testing, it may not always be feasible in a small group of patients. Hence, this study aims to determine the computed tomography (CT) features that may predict the presence of common sensitising EGFR mutation in newly diagnosed advanced lung adenocarcinoma patients. Methods: 182 diagnostic contrast enhanced CT-images of newly diagnosed advanced lung adenocarcinoma patients who attended University Malaya Medical Center from 2010 to 2014 were analysed. For EGFR mutation testing, tissue biopsy specimens of all patients were tested for exon 19 deletion and exon 21 L858R point mutation. Results: Of the 182 patients, 158 patients with measurable primary tumour, were included in the analysis. 67 (42.4%) patients had common sensitising EGFR mutations, of which 43 (64.1%) were exon 19 deletion and 24 (35.9%) were exon 21 L858R point mutation. CT features of these patients are stated in Table 1. Common sensitising EGFR mutations were significantly more common in primary tumours with round contour (p ¼ 0.029), homogenous enhancement (p ¼ 0.029) and presence of air-bronchogram (p ¼ 0.029). On the other hand, presence of emphysema (p ¼ 0.005) and intrathoracic lymph nodes enlargement (p ¼ 0.001) were significantly against the presence of common sensitising EGFR mutations. These findings were further supported by the multivariate analysis: round contour [odd ratio (OR): 13.6, 95% confidence interval (CI): 1.40 - 13.2, p ¼ 0.024], homogenous enhancement (OR: 2.5, 95% CI: 1.00 - 6.47, p ¼ 0.049), presence of air bronchogram (OR: 2.7, 95% CI: 1.28 e 5.53, p ¼ 0.009) and intrathoracic lymph nodes enlargement (OR: 0.2, 95% CI: 0.05 - 0.52, p ¼ 0.002). None of the CT features could differentiate exon 19 deletion from exon 21 L858R point mutation. Conclusion: Tumours with round contour, homogenous enhancement and air bronchogram as well as absence of intrathoracic lymph nodes enlargement were independent predictors of the presence of common sensitising EGFR mutations. This information is helpful to clinicians in selecting best empirical treatment for patients who are not eligible for tissue biopsy and in those who need urgent treatment because of rapid clinical deterioration. Elsevier 2021-03-01 Article PeerReviewed text en http://ir.unimas.my/id/eprint/34903/1/abstract.pdf Chai, Chee Shee (2021) Qualitative Computed Tomographic Features Predict Epidermal Growth Factor Receptor Mutations in Advanced Lung Adenocarcinoma. Journal of Thoracic Oncology, 16 (3). pp. 558-560. ISSN 1556-0864 https://doi.org/10.1016/j.jtho.2021.01.1005
institution Universiti Malaysia Sarawak
building Centre for Academic Information Services (CAIS)
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Malaysia Sarawak
content_source UNIMAS Institutional Repository
url_provider http://ir.unimas.my/
language English
topic R Medicine (General)
RC Internal medicine
RC0254 Neoplasms. Tumors. Oncology (including Cancer)
spellingShingle R Medicine (General)
RC Internal medicine
RC0254 Neoplasms. Tumors. Oncology (including Cancer)
Chai, Chee Shee
Qualitative Computed Tomographic Features Predict Epidermal Growth Factor Receptor Mutations in Advanced Lung Adenocarcinoma
description Introduction: Current guidelines recommend reflex testing for EGFR mutations in patients with advanced lung adenocarcinoma. Although tissue biopsy is considered the “gold standard” for EGFR mutation testing, it may not always be feasible in a small group of patients. Hence, this study aims to determine the computed tomography (CT) features that may predict the presence of common sensitising EGFR mutation in newly diagnosed advanced lung adenocarcinoma patients. Methods: 182 diagnostic contrast enhanced CT-images of newly diagnosed advanced lung adenocarcinoma patients who attended University Malaya Medical Center from 2010 to 2014 were analysed. For EGFR mutation testing, tissue biopsy specimens of all patients were tested for exon 19 deletion and exon 21 L858R point mutation. Results: Of the 182 patients, 158 patients with measurable primary tumour, were included in the analysis. 67 (42.4%) patients had common sensitising EGFR mutations, of which 43 (64.1%) were exon 19 deletion and 24 (35.9%) were exon 21 L858R point mutation. CT features of these patients are stated in Table 1. Common sensitising EGFR mutations were significantly more common in primary tumours with round contour (p ¼ 0.029), homogenous enhancement (p ¼ 0.029) and presence of air-bronchogram (p ¼ 0.029). On the other hand, presence of emphysema (p ¼ 0.005) and intrathoracic lymph nodes enlargement (p ¼ 0.001) were significantly against the presence of common sensitising EGFR mutations. These findings were further supported by the multivariate analysis: round contour [odd ratio (OR): 13.6, 95% confidence interval (CI): 1.40 - 13.2, p ¼ 0.024], homogenous enhancement (OR: 2.5, 95% CI: 1.00 - 6.47, p ¼ 0.049), presence of air bronchogram (OR: 2.7, 95% CI: 1.28 e 5.53, p ¼ 0.009) and intrathoracic lymph nodes enlargement (OR: 0.2, 95% CI: 0.05 - 0.52, p ¼ 0.002). None of the CT features could differentiate exon 19 deletion from exon 21 L858R point mutation. Conclusion: Tumours with round contour, homogenous enhancement and air bronchogram as well as absence of intrathoracic lymph nodes enlargement were independent predictors of the presence of common sensitising EGFR mutations. This information is helpful to clinicians in selecting best empirical treatment for patients who are not eligible for tissue biopsy and in those who need urgent treatment because of rapid clinical deterioration.
format Article
author Chai, Chee Shee
author_facet Chai, Chee Shee
author_sort Chai, Chee Shee
title Qualitative Computed Tomographic Features Predict Epidermal Growth Factor Receptor Mutations in Advanced Lung Adenocarcinoma
title_short Qualitative Computed Tomographic Features Predict Epidermal Growth Factor Receptor Mutations in Advanced Lung Adenocarcinoma
title_full Qualitative Computed Tomographic Features Predict Epidermal Growth Factor Receptor Mutations in Advanced Lung Adenocarcinoma
title_fullStr Qualitative Computed Tomographic Features Predict Epidermal Growth Factor Receptor Mutations in Advanced Lung Adenocarcinoma
title_full_unstemmed Qualitative Computed Tomographic Features Predict Epidermal Growth Factor Receptor Mutations in Advanced Lung Adenocarcinoma
title_sort qualitative computed tomographic features predict epidermal growth factor receptor mutations in advanced lung adenocarcinoma
publisher Elsevier
publishDate 2021
url http://ir.unimas.my/id/eprint/34903/1/abstract.pdf
http://ir.unimas.my/id/eprint/34903/
https://doi.org/10.1016/j.jtho.2021.01.1005
_version_ 1695535569321328640
score 13.211869

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