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Vol.56 No.3 contents | Japanese/English |
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- Case Report -
Three Cases of an Unsuccessful Histopathological Diagnosis of Bronchoscopic Re-biopsy Specimens from EGFR-mutant Adenocarcinoma Patients After EGFR-TKI Therapy
Kei Morikawa1,3, Noriaki Kurimoto2, Kazutaka Kakinuma1, Naoki Furuya1, Teruomi Miyazawa1, Masamichi Mineshita11Division of Respiratory Medicine, Department of Internal Medicine, 2Division of Chest Surgery, Department of Surgery, St. Marianna University School of Medicine, Japan, 3NBC Counter Medical Unit, Japan Ground Self-Defense Force, Japan
Background. The clinical use of 3rd generation epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) has become more important in the treatment of patients in whom T790M mutations are detected. At present, however, bronchoscopic re-biopsy is not widely conducted. We report three cases of bronchoscopic re-biopsy in patients with EGFR-mutant adenocarcinoma. Case Reports. Cases 1 and 2 were classified as stage IV (EGFR mutation: exon19 deletion), while case 3 was classified as stage I (EGFR mutation: exon21 L858R point mutation) with poor lung function and multiple ground-glass nodules (GGNs) at other lobes. All patients received EGFR-TKI as a 1st line therapy. The treatments were discontinued due to disease progression, and subsequent bronchoscopic re-biopsies of the primary lesions were performed. Case 1: EBUS showed curved echoes around the access bronchus, making it difficult to collect a tissue sample with a forceps. The cytological diagnosis confirmed class V with an exon19 deletion, without a T790M mutation; the histopathological diagnosis was negative. Case 2: EBUS revealed the guide-sheath adjacent to the target lesion. However, both the cytological and histopathological results were negative. Case 3: EBUS showed the target lesion, but the number of procedures was reduced due to bleeding. Although exon21 L858R and T790M mutations were detected from the cytological sample, the histopathological results were negative. Conclusion. Bronchoscopic re-biopsy appears to be difficult due to pathological tissue changes and tumor shrinkage after treatment. The targeted lesion and diagnostic procedures should be carefully selected in response to each case.
key words: EGFR-mutant NSCLC, Re-biopsy, Bronchoscopy
Received: January 25, 2016
Accepted: March 24, 2016
JJLC 56 (3): 219-226, 2016
