ABSTRACT
The detection of molecular alterations is crucial for the individualized treatment of advanced non-small cell lung cancer (NSCLC). Missing targetable alterations may have a major impact on patient's progression free and overall survival. Although laboratory testing for molecular alterations has continued to improve; little is known about how biopsy technique affects the detection rate of different mutations. In the retrospective study detection rate of epidermal growth factor (EGFR) mutations in tissue extracted by bronchoscopic cryobiopsy (CB was significantly higher compared to other standard biopsy techniques. This prospective, randomized, multicenter, single blinded study evaluates the accuracy of molecular genetic characterization of NSCLC for different cell sampling techniques. Key inclusion criteria are suspected lung cancer or the suspected relapse of known NSCLC that is bronchoscopically visible. Patients will be randomized, either to have a CB or a bronchoscopic forceps biopsy (FB). If indicated, a transbronchial needle aspiration (TBNA) of suspect lymph nodes will be performed. Blood liquid biopsy will be taken before tissue biopsy. The primary endpoint is the detection rate of molecular genetic alterations in NSCLC, using CB and FB. Secondary endpoints are differences in the combined detection of molecular genetic alterations between FB and CB, TBNA and liquid biopsy. This trial plans to recruit 540 patients, with 178 evaluable patients per study cohort. A histopathological and molecular genetic evaluation will be performed by the affiliated pathology departments of the national network for genomic medicine in lung cancer (nNGM), Germany. We will compare the diagnostic value of solid tumor tissue, lymph node cells and liquid biopsy for the molecular genetic characterization of NSCLC. This reflects a real world clinical setting, with potential direct impact on both treatment and survival.
ABSTRACT
Mentalizing, i.e. the process of inferring another person's mental state, is thought to be primarily subserved by three brain regions, the VMPFC (ventromedial prefrontal cortex), precuneus and TPJ (temporo-parietal junction). However, it is still unclear what the exact roles of these regions in mentalizing are. Here, we compare activity within, and functional connectivity between, the VMPFC, precuneus and TPJ during two different mentalizing tasks. Specifically, we examine whether inferring another person's emotion ("emotion mentalizing") and inferring another person's intention ("intention mentalizing") activate similar or distinct subregions within the VMPFC, precuneus and TPJ, and whether these different kinds of mentalizing are associated with different patterns of functional connectivity between these regions. Our results indicate that emotion mentalizing and intention mentalizing activate partly distinct subregions of the right and left TPJ that can be spatially separated across participants. These subregions also showed different patterns of functional connectivity with the VMPFC: a more anterior region of the right and left TPJ, which was more strongly activated during emotion mentalizing, showed stronger functional connectivity with the VMPFC, particularly during emotion mentalizing, than a more posterior region that was more strongly activated during intention mentalizing. Critically, this double dissociation became evident only when the fine-scale distribution of activity within activated regions was analysed, and despite the fact that there was also a significant overlap of activity during the two tasks. Our findings provide first evidence that different neural modules might have evolved within the TPJ that show distinct patterns of functional connectivity and might subserve slightly different subfunctions of mentalizing.
