Success of genomic profiling of non-small cell lung cancer biopsies obtained by trans-thoracic percutaneous needle biopsy.

PURPOSE: Genomic profiling for personalized targeted therapy has become standard of care. We report the success of genomic profiling of non-small cell lung cancer (NSCLC) obtained by trans-thoracic needle biopsy (TTNB) in a single center experience. MATERIALS AND METHODS: Patients with NSCLC who underwent TTNB for genomic were identified. Pathology specimens were evaluated for tumor adequacy and then analyzed for selected exons of epidermal growth factor receptor, KRAS, BRAF, PIK3CA, and ERBB2. ALK rearrangements were detected with fluorescence in situ hybridization and/or immunohistochemistry. Technical success was recorded and the factors affecting successful profiling were evaluated. Complications (pneumothorax, hemorrhage, and admission) were recorded. Comparison of yield and complications were done between the two groups (core biopsy and fine needle aspiration only group). Utility of PET-CT to guide the needle track for optimized yield was assessed in a subset of patients. RESULTS: Between December 6, 2009, and December 30, 2016, 765 patients with NSCLC underwent TTNB. Five-hundred and seventy-seven of 765 (75%) of all TTNB were profiled, for genomic analysis. Five-hundred and eight of 577 (88%) were successfully profiled. The number of samples obtained ranged from 1 to 10 (1 to 2 cm, 18 to 20 G). Lesions biopsied ranged in size from 0.6 to 16 cm. No statistically significant difference was observed in the incidence of pneumothorax between two groups (P = 0.26). PET guidance was not found to be statistically significant ( P = 0.79) in the overall yield. CONCLUSION: Computed tomographic guided TTNB is a safe and efficacious technique for genomic profiling, enables the acquisition of sufficient tissue for genetic mutation analyses allowing for personalized therapy with an acceptable complication rate.

Intralesional bone marrow and superior check desmotomy is superior to conservative treatment of equine superficial digital flexor tendonitis.

BACKGROUND: Superficial digital flexor tendon (SDFT) injury is common in racehorses and a significant cause of lost training days and wastage in the industry. OBJECTIVES: To compare the post-injury performance of Thoroughbred and Standardbred racehorses diagnosed with SDFT tendonitis treated with intralesional bone marrow and superior check desmotomy or managed conservatively and further to compare this performance with that of uninjured racehorses. STUDY DESIGN: Retrospective and case-controlled. METHODS: Medical and race records of racehorses treated surgically or managed conservatively for SDFT tendonitis were collated. Signalment, lesion severity and treatment were identified and performance post-injury compared. Performance of the treatment groups was further assessed by comparison with uninjured racehorses matched for age, sex, number of starts pre-injury and randomly selected from the cases' last races. RESULTS: The study population comprised 114 racehorses divided into surgical (39/114), conservative (38/114) and control groups (37/114). Horses that had surgery were more likely to return to racing than those managed conservatively (OR 4.7 95% CI [1.6-14.3], P = .006). Standardbreds were more likely to return to race compared with Thoroughbreds (OR 4.0 95% CI [1.2-13.3], P = .03). There was no statistically significant difference in the average number of placings, average number of wins and post-injury earnings between the surgically treated and conservatively managed groups (P = .9, P = .9 and P = .7, respectively). The average number of lifetime starts post-injury/post-selection between surgery, conservative and control groups were not statistically significantly different (P = .2). Surgically treated horses had a statistically significantly shorter time to start post-injury compared with the conservative group (P = .04). MAIN LIMITATIONS: The retrospective nature of the study precludes an actual fit as a nonrandomised clinical trial and the nonrandomised nature of the allocation of the treatment groups is biased. CONCLUSIONS: Surgical intervention of superficial digital flexor tendonitis in racehorses suffering flexor tendon injury showed a higher likelihood of return to racing than conservative treatment.