Review Article

The Emergent Landscape of Detecting EGFR Mutations Using Circulating Tumor DNA in Lung Cancer

Table 1

Recent advancement of techniques for detecting EGFR mutation using ctDNA in lung cancer.

Study teamSampleOncogene mutationSample sizeMethodConclusion

Wang et al.PlasmaEGFR68 (III/IV)ARMS/Scorpion assaySensitivity (22.06%), specificity (96.97%), positive predictive value (88.24%), and negative predictive value (54.70%) [20]

Liu et al.PlasmaEGFR86 (III/IV)ARMSSensitivity (67.5%), specificity (100%), and concordance rate was 84.9% [21].

Goto et al.PlasmaEGFR86 (III/IV)ARMS/Scorpion assaySensitivity (43.1%), specificity (100%), positive predictive value (100%), negative predictive value (54.7%), and concordance ratio (66.3%) [22]

Kimura et al.PlasmaEGFR42 (advanced stage)ARMS/Scorpion assaySensitivity (85.7%), specificity (94.2%), and concordance ratio (92.9%) [23]

Kimura et al.PlasmaEGFR27 (III/IV)ARMS/ScorpionDetection rate 48.1% [24]

Yung et al. PlasmaEGFR35 (III/IV)Digital PCRSensitivity (92%) and specificity (100%) [28]

Brevet et al. PlasmaEGFR34 (III/IV)Mass spectrometry genotypingDetection rate 61% [51]

Hu et al.PlasmaEGFR24 (I/II/III/IV)High-resolution melting analysisPositive rate was 100% for patients in stages II–IV, 81.8% (9/11) for stage I. The sensitivity was 91.67% and specificity was 100% [52].

Zhao et al.PlasmaEGFR111 (I/II/III/IV)Mutant-enriched PCRConcordance ratio (71.2%), sensitivity (35.6%), and specificity (95.5%). Sensitivity varied according to the disease stage and pathological differentiation; early stage (10%) versus advanced stage (56%). Highly differentiated (20%) patients and moderately differentiated (19%) and poorly differentiated subgroup (77.8%) [31].

Jiang et al. PlasmaEGFR58 (III/IV)Mutant-enriched PCR Sensitivity (77.8%), specificity (100%), and concordance rate (93.1%), more sensitive than the nonenriched assay [32].

Bai et al. PlasmaEGFR230 (III/IV)DHPLCSensitivity 81.8% and specificity 89.5% [57]

Kim et al. PlasmaEGFR35 (III/IV)PNA-mediated PCR Concordance in the serum and tumor samples was 17% [42].

Kim et al. PlasmaEGFR57 (III/IV)PNA–LNA PCR clampConcordance in the serum and tumor samples was 87.7% [43].

Xu et al. Plasma EGFR 51 (III/IV)ARMS/Scorpion assaySensitivity (50.0%)   Specificity (100%) [25]
Mutant-enriched PCRSensitivity (25.0%)   Specificity (96.2%)
DHPLCSensitivity (25.0%)   Specificity (92.3%)
60 (III/IV)Direct sequencing versus Mutant-enriched PCRSensitivity 18.3% versus 55.0% [33]

Kuang et al. PlasmaEGFR
−T790M
54 (III/IV)ARMS/Scorpion assayDetected in 54% of patients with prior clinical response to TKI and 29% of prior stable disease [19]

Taniguchi et al. PlasmaEGFR
−T790M
44 (III/IV)BEAMing82.6% detection rate in patient who developed PD after EGFR TKI and 43.5% detection rate in patients were never treated with EGFR TKI [48]

Sakai et al. PlasmaEGFR
−T790M
75 (III/IV)Mass spectrometry genotyping28% detection rate in patient who developed PD after EGFR TKI [50].

Kukita et al. PlasmaEGFR144 (III/IV)Next-generation sequencers: Ion Torrent PGM72.7% detection rate in exon 19 deletion, 78.2% detection rate in L858R or L861Q [66]

Couraud et al. PlasmaEGFR (exons 18, 19, 20, and 21)68 (I/II/III/IV)Next-generation sequencers: Ion Torrent PGMSensitivity ranged from 55% (EGFR exon 19) to 100% (EGFR exon 18) Considering all amplicons, the sensitivity was 58% and the concordance rate was 68% [67].

Wei et al. SalivaEGFR40 (III/IV)EFIRMExon 19 Del (AUCs = 0.94, 95% CI, 0.82–1) and L858R (AUCs = 0.96, 95% CI, 0.90–1) [80]

ARMS: amplification-refractory mutation system; DHPLC: denaturing high performance liquid chromatography; PNA: peptide nucleic acid; PNA-LNA: peptide nucleic acid-locked nucleic acid; BEAMing: beads, emulsions, amplification, and magnetics; NGS: next-generation sequencing; Ion Torrent PGM: Ion Torrent Personal Genome Machine (PGM) System; EFIRM: electric field-induced release and measurement.