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Published on: September 25, 2018
[Molecular pathological diagnosis in cytopathology of non-small-cell lung cancer. Standardization of specimen
1Institut für Pathologie, Universität Heidelberg, Im Neuenheimer Feld 224, Heidelberg, Germany. arne.warth@med.uni-heidelberg.de
Background:
Personalized medicine is becoming standard for the treatment of non-small-cell lung cancer. For example, patients with activating EGFR mutations or EML4-ALK translocations largely benefit from targeted therapies with tyrosine kinase inhibitors with better response rates and progression-free survival compared to standard chemotherapy regimens. However, the application of the respective molecular biomarker analyses requires great expertise in the handling of different cell and tissue specimens. A major challenge for reliable analyses is the usually low amount of tumor material. There are currently relatively few standardized and evidence-based guidelines for the processing and analysis of respective specimens as well as for interpretation of the test results.
Materials And Methods:
To establish a basis for standardized predictive cytopathological analyses, different material processing approaches and molecular pathological tests are discussed, and novel concepts and strategies are lined out in order to improve the quality and reliability of the respective diagnostic procedures.
Results And Discussion:
Predictive analyses of cytological specimens can be reliably performed using smears, cytospins or cell blocks; there is no need for histological specimens. The diagnostic work-up of cytological probes should be performed as carefully as possible in order to save further tumor material for subsequent predictive analyses. With standardized and reliable procedures at hand cytopathology is an important contribution to the multidisciplinary, complex care, and treatment of lung cancer patients.
Insights
Cytological specimens, not histology, are sufficient for predictive molecular analyses in non-small cell lung cancer. Careful processing of these samples ensures reliable results for personalized treatment strategies.
Area of Science:
- Oncology
- Molecular Pathology
- Cytopathology
Background:
- Personalized medicine is standard for non-small cell lung cancer (NSCLC).
- EGFR mutations and EML4-ALK translocations predict response to targeted therapies.
- Limited tumor material and lack of standardized guidelines challenge molecular biomarker analysis.
Purpose of the Study:
- To establish a basis for standardized predictive cytopathological analyses in NSCLC.
- To discuss material processing approaches and molecular pathology tests.
- To outline novel strategies for improving diagnostic quality and reliability.
Main Methods:
- Review of material processing approaches for cytological specimens.
- Discussion of molecular pathology tests for predictive biomarker analysis.
- Exploration of novel concepts for diagnostic procedures.
Main Results:
- Predictive analyses are reliably performed on smears, cytospins, or cell blocks.
- Histological specimens are not required for predictive analyses.
- Careful diagnostic work-up preserves tumor material for further testing.
Conclusions:
- Cytopathology provides a reliable basis for predictive analyses in NSCLC.
- Standardized cytopathological procedures enhance diagnostic quality.
- Cytopathology is crucial for multidisciplinary lung cancer patient care.
