Optimal image guidance for tumor biopsy in non-small-cell lung cancer
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LETTER TO THE EDITOR
Optimal image guidance for tumor biopsy in non-small-cell lung cancer Liang Zhao 1 & Qin Lin 1 & Haojun Chen 2 Received: 12 April 2020 / Accepted: 22 April 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Dear Sir, We have read with great interest the article published by Wang et al. [1], which suggested that the SUVmax on 18Ffluorodeoxyglucose (FDG) PET/CT was a potential predictor to select candidates for immunotherapy. There is increasing evidence indicating that PD-L1 expression correlates positively with FDG uptake in non-small-cell lung cancer (NSCLC) [1–4]. It is conceivable that it may be more appropriate to use 18 F-FDG PET/CT-guided core biopsy than regular CT-guided biopsy for the PD-L1 test in patients with NSCLC. Meanwhile, another recent article, which aims to improve tumor biopsy practices, recommended endobronchial ultrasound-guided bronchoscopy with transbronchial needle aspiration (EBUS-TBNA) or bronchoscopy for acquiring biopsy tissue in lung cancer research [5]. Here, we would like to share an opinion that future clinical research should consider using 18F-FDG PET/CT-guided core biopsy for non-small-cell lung cancer (NSCLC). A high success rate is essential in tumor biopsy. In Levy et al.’s article, PET/CT-guided biopsy was preferred in cases of metastatic lung cancer because it helps to resolve the issue of sampling error and to identify the most appropriate site for biopsy, while EBUS-TBNA was recommended for primary tumor biopsy [5]. However, PET/CT-guided biopsy could be also preferred for the primary lesion because of the improved success rate [6]; this may have been due to the better identification of the lesion site after interpretation of metabolic This article is part of the Topical Collection on Letter to the Editor * Haojun Chen [email protected] 1
Department of Radiation Oncology, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, China
2
Department of Nuclear Medicine & Minnan PET Center, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, China
features provided by this imaging procedure. For example, 18 F-FDG PET/CT-guided biopsy is more accurate for NSCLC with pulmonary atelectasis [7]. Moreover, PET/CT allows identification of FDG-avid lesions that are most accessible to biopsy, from among multiple lesions with similar FDG uptake. Biopsy of the most accessible lesion can minimize sampling error and reduce the risk of complications associated with this procedure. In the era of precision medicine, immunotherapies and targeted therapies are keenly researched for the treatment of NSCLC. High-quality specimens allow for detailed molecular pathological diagnosis to guide optimal therapy. However, the inevitable intra-tumor heterogeneity would markedly affect the results of molecular pathology investigations. For example, Ilie et al. demonstrated poor concordance of the PD-L1 status
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