[Strategy for molecular testing in pulmonary carcinoma]

Area of Science:

• Oncology
• Molecular Diagnostics
• Pathology

Background:

• Lung cancer management relies heavily on theranostic molecular marker analysis.
• Many lung cancers are diagnosed at advanced stages, necessitating molecular screening on limited tissue samples.
• Accurate histopathological characterization of small biopsies is essential for classifying tumors like non-small cell carcinoma (NSCC).

Purpose of the Study:

• To outline an optimized molecular screening strategy for small lung cancer biopsies.
• To prioritize molecular tests based on available targeted therapies.
• To explore the role of emerging technologies like next-generation sequencing and liquid biopsies.

Main Methods:

• Histopathological characterization using WHO 2015 classification.
• Tissue-sparing strategies for immunohistochemistry, in situ hybridization (e.g., ALK), and DNA-based tests (e.g., EGFR, KRAS).
• Prioritization of tests for actionable mutations and inclusion of emerging biomarkers (HER2, ROS1, RET, BRAF).

Main Results:

• A tiered testing approach is proposed, starting with essential markers and progressing to broader genomic profiling.
• Next-generation sequencing enables sensitive detection of minority clones.
• Liquid biopsies offer a non-invasive method for monitoring treatment resistance.

Conclusions:

• An efficient molecular screening strategy is vital for guiding lung cancer treatment, especially with limited tissue.
• Advanced molecular techniques enhance diagnostic accuracy and therapeutic options.
• Liquid biopsies represent a promising non-invasive approach for ongoing patient management.