TITLE: Multigene PCR using both cfDNA and cfRNA in the supernatant of pleural effusion achieves accurate and rapid detection of mutations and fusions of driver genes in patients with advanced NSCLC
SUMMARY: In advanced NSCLC, pleural effusion makes for good specimens for molecular analysis, and can be quite useful sans tissue samples. Nevertheless, the detection of multiple driver gene mutations in pleural effusion specimens can be difficult.
In the current study, researchers included 77 patients with advanced NSCLC and plural effusion. Of these patients, 49 also had matched tumor tissues. The investigators prepared supernatants, cell blocks, and cell sediments from pleural effusion samples to isolate driver alterations via a PCR-based 9-gene mutation kit.
The researchers found that mutations in EGFR, KRAS, and HER2 were detected in DNA and cfDNA, whereas fusions in ALK was detected in RNA and cfRNA. The supernatant demonstrated highest overall sensitivity versus matched tumor tissue samples (81.3%), followed by cell blocks (71.0%), and cell sediments (66.7%)
“Our study indicated that supernatant of pleural effusion specimens can achieve cfDNA‐based SNV/Indels and cfRNA‐based fusion variations detection,” concluded the authors. “Compared with cytology specimens, the supernatant has the highest overall detection sensitivity, and the TAT [turnaround time] of molecular testing is the shortest, the mutation results can be obtained on the day the pleural effusion is obtained. The entire detection process of pleural effusion supernatant was easy to operate and with short TAT, which was more suitable for clinical application.”
QUESTION: Do you think that the supernatant of pleural effusions is underutilized in diagnosing advanced NSCLC? Why or why not?
1 Department of Pathology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis And Thoracic Tumor Research Institute, Beijing, China. 2 Medical Department, Amoy Diagnostics Co., Ltd., Xiamen, China. 3 Department of Oncology, Shanghai Chest Hospital Shanghai Jiaotong University, Shanghai, China.