背景:分子检测可以检测非小细胞肺癌(NSCLC)患者中可行的基因组改变和肿瘤细胞表面蛋白。然而,利用率仍然次优,代表错过的治疗机会。本研究旨在确定在晚期NSCLC患者中获得经皮肺穿刺活检标本以进行成功分子检测的挑战和潜在解决方案。
方法:这项跨学科的定性研究包括来自美国各地学术和社区环境的10名放射科医师和4名病理学家,他们常规进行和分析经皮肺穿刺活检。参与者进行了半结构化的一对一访谈(第一阶段)。访谈问卷是根据对关键查询线的文献综述构建的,由专业市场研究人员使用理论领域框架进行。使用主题分析确定了分子测试的主要障碍。随后,多学科焦点小组被召集,以确定潜在的解决方案(第2阶段)。
结果:四个主题成为分子检测的障碍,并与临床工作流程相匹配:(1)活检请求,(2)活检程序,(3)试样分析,(4)沟通。19种潜在的解决方案包括在活检请求中添加一个“复选框”以指示分子检测,利用术前成像来指导活检,通过适当的分配策略和下一代测序面板来保护组织,而不是顺序的单基因测定,在NSCLC诊断时建立反射分子检测,多学科肿瘤委员会跟踪和沟通活检结果,并改善放射科医生和病理学家与肿瘤护理团队的整合。
结论:存在增加晚期NSCLC患者肺穿刺活检标本分子检测成功率的潜在解决方案。
BACKGROUND: Molecular testing can detect actionable genomic alterations and tumor cell surface proteins in patients with non-small cell lung cancer (NSCLC). However, utilization remains suboptimal, representing missed treatment opportunities. This study aimed to identify challenges and potential solutions to obtaining percutaneous lung needle biopsy specimens for successful molecular testing in patients with advanced NSCLC.
METHODS: This interdisciplinary qualitative study included ten radiologists and four pathologists from academic and community settings across the United States who routinely perform and analyze percutaneous lung needle biopsies. Participants underwent semi-structured one-on-one interviews (Phase 1). Interview questionnaires were constructed based on a literature review of key lines of inquiry and conducted by professional market researchers using the theoretical domains framework. Primary barriers to molecular testing were identified using thematic analysis. Subsequently, multidisciplinary focus groups were convened to identify potential solutions (Phase 2).
RESULTS: Four themes emerged as barriers to molecular testing and were matched to the clinical workflow: (1) biopsy request, (2) biopsy procedure, (3) specimen analysis, and (4) communication. The nineteen potential solutions included adding a \"checkbox\" to indicate molecular testing in the biopsy request, leveraging pre-procedural imaging to guide biopsies, conserving tissue through appropriate allocation strategies and next generation sequencing panels instead of sequential single-gene assays, instituting reflex-molecular testing upon NSCLC diagnosis, tracking and communicating biopsy outcomes at multidisciplinary tumor boards, and improving integration of radiologists and pathologists into oncology care teams.
CONCLUSIONS: Potential solutions exist to increase successful molecular testing of lung needle biopsy specimens in patients with advanced NSCLC.