Tuberc Respir Dis.  2013 Nov;75(5):181-187.

Biopsy and Mutation Detection Strategies in Non-Small Cell Lung Cancer

• Jung CY

Abstract

The emergence of new therapeutic agents for non-small cell lung cancer (NSCLC) implies that histologic subtyping and molecular predictive testing are now essential for therapeutic decisions. Histologic subtype predicts the efficacy and toxicity of some treatment agents, as do genetic alterations, which can be important predictive factors in treatment selection. Molecular markers, such as epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) rearrangement, are the best predictors of response to specific tyrosine kinase inhibitor treatment agents. As the majority of patients with NSCLC present with unresectable disease, it is therefore crucial to optimize the use of tissue samples for diagnostic and predictive examinations, particularly for small biopsy and cytology specimens. Therefore, each institution needs to develop a diagnostic approach requiring close communication between the pulmonologist, radiologist, pathologist, and oncologist in order to preserve sufficient biopsy materials for molecular analysis as well as to ensure rapid diagnosis. Currently, personalized medicine in NSCLC is based on the histologic subtype and molecular status. This review summarizes strategies for tissue acquisition, histologic subtyping and molecular analysis for predictive testing in NSCLC.

Keyword

Carcinoma, Non-Small-Cell Lung; Biopsy; Mutation

MeSH Terms

Biopsy*
Carcinoma, Non-Small-Cell Lung*
Diagnosis
Humans
Precision Medicine
Lymphoma
Phosphotransferases
Protein-Tyrosine Kinases
Receptor Protein-Tyrosine Kinases
Receptor, Epidermal Growth Factor
Phosphotransferases
Protein-Tyrosine Kinases
Receptor Protein-Tyrosine Kinases
Receptor, Epidermal Growth Factor

Figure

• 

  Figure 1 A diagnostic algorithm for histologic subtyping and molecular analysis in non-small cell lung cancer (NSCLC) diagnosis. SCLC: small cell lung cancer; H&E: hematoxylin and eosin; SQCC: squamous cell carcinoma; ADC: adenocarcinoma; NOS: not otherwise specified; TTF-1: thyroid transcription factor-1; CK: cytokeratin; IHC: immunohistochemistry; EGFR: epidermal growth factor receptor; TKI: thyrosine kinase inhibitor; ALK: anaplastic lymphoma kinase; FISH: fluorescence in situ hybridization.

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