MAGE qPCR Improves the Sensitivity and Accuracy of EBUS-TBNA for the Detection of Lymphatic Cancer Spread

• Published in: Journal of thoracic oncology 2012-04, Vol.7 (4), p.690-697
• Main Authors: Cucuruz, Beatrix, Dango, Sebastian, Jurinovic, Vindi, Mayer, Olga, Follo, Marie, Böhm, Joachim, Freudenberg, Nikolaus, Elze, Mirjam, Sienel, Wulf, Klein, Christoph A., Passlick, Bernward, Polzer, Bernhard
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biopsy, Fine-Needle; Endobronchial ultrasound-guided fine-needle aspiration (EBUS-TBNA); Endosonography; HT29 Cells; Humans; Lung Neoplasms - pathology; Lymph node metastasis; Lymphatic Metastasis; Mediastinoscopy; Melanoma antigen (MAGE); Melanoma-Specific Antigens - genetics; Middle Aged; Non-small cell lung cancer (NSCLC); Polymerase Chain Reaction - methods; RNA, Messenger - analysis
• ISSN: 1556-0864; 1556-1380
• DOI: 10.1097/JTO.0b013e31824294de

Microscopic examination of histologic slides or cytologic specimens of mediastinal lymph node samples obtained by diagnostic mediastinoscopy or endobronchial ultrasound-guided fine-needle aspiration (EBUS-TBNA) is routinely used for the staging of lung cancer patients. Therefore, we explored whether the detection of tumor-associated mRNA in lymph node samples from patients with suspected lung cancer adds diagnostic accuracy to conventional histopathological staging. We examined 202 lymph nodes obtained by EBUS-TBNA or mediastinoscopy from 89 patients with lung cancer. Lymph node samples from patients with nonmalignant disease were available as controls (60 samples from 31 patients). Real-time quantitative mRNA analysis was performed for melanoma antigen-A genes (MAGE-A 1–6, MAGE-A 12) using a LightCycler 480 instrument. MAGE transcript levels in control and cancer patients differed widely, and the 95% confidence interval served to define the threshold between negative and positive samples. MAGE 1 to 6 transcripts were detected in 35 of 122 (28.7%) lymph nodes obtained by EBUS-TBNA and 16 of 80 (20.0%) lymph nodes obtained by mediastinoscopy. MAGE 12 transcripts were detected in 10 of 122 (8.2%) lymph nodes obtained by EBUS-TBNA and 9 of 80 (11.3%) lymph nodes obtained by mediastinoscopy. Although the accuracy of histopathological diagnosis after EBUS-TBNA and mediastinoscopy was 69.6% and 84.1%, respectively, it increased to 81.2% and 86.4%, respectively, when combined with MAGE-quantitative polymerase chain reaction. The combination of EBUS-TBNA and MAGE-quantitative polymerase chain reaction increases the accuracy of tumor cell detection to the level seen with mediastinoscopy.