. Step 13 of 40
Clinical Stem 2
A patient with pulmonary nodules 1 year after curative intent resection of primary lung adenocarcinoma

Answer B
For EGFR tests, expert consensus currently suggests performing 4-5 biopsies to obtain more than 300 cells per biopsy. For ALK translocation testing using FISH, more than 100 assessable tumor cell nuclei are recommended.

Bronchoscopic forceps biopsies provide sufficient tissue for diagnosis and molecular analysis. Significantly larger biopsies and artifact-free tissue specimens are reported after cryobiopsy of endobronchial lesions.

Regardless of how they are obtained, biopsy specimens should be immediately fixed in an adequate amount of neutral buffered 10% formalin, usually at a ratio of 5?10 to biopsy volume, and embedded in paraffin, creating a formalin-fixed, paraffin-embedded tissue, also known as FFPE. A fixation time of 6 to 12 hours for small biopsy samples is considered optimal.
Before samples are sent for molecular analysis, the specimen's tumor cell content should be assessed by the pathologist to enhance the reliability of subsequent molecular test results.

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References:
  1. Pirker R, Herth FJF, Kerr KM, et al. Consensus for EGFR mutation testing in non-small cell lung cancer: results from a European workshop. J Thorac Oncol 2010; 5: 1706?13.
  2. Eberhard DA, Giaccone G, Johnson BE. Biomarkers of response to epidermal growth factor receptor inhibitors in Non-Small-Cell Lung Cancer Working Group: standardization for use in the clinical trial setting. J Clin Oncol 2008; 26: 983?94.
  3. Thunnissen E, Kerr KM, Herth FJ, et al. The challenge of NSCLC diagnosis and predictive analysis on small samples. Practical approach of a working group. Lung Cancer 2012; 76: 1-18.
  4. Schumann S, Hetzel J, Babiak A et al. Cryoprobe biopsy increases the diagnostic yield in endobronchial tumor lesions. J Thorac Cardiovasc Surg 2010;140:417-421.
  5. Griff S, Ammenwerth W, Schonfeld et al. Morphometrical analysis of transbronchial cryobiopsies. Diagn Pathol. 2011 Jun 16;6:53.
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