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Nichtkleinzellige Lungenkarzinome

Subklassifikation und prädiktive molekulare Markeruntersuchungen in der Zytologie

Non-small cell lung cancer

Subtyping and predictive molecular marker investigations in cytology

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Zusammenfassung

In der Lungenkarzinomdiagnostik haben sich die Anforderungen an die Zytologie in den letzen Jahren deutlich verändert. Eine exakte Subtypisierung nichtkleinzelliger Lungenkarzinome (NSCLC) in Adeno- und Plattenepithelkarzinome entscheidet sowohl über die Wahl der Chemotherapie als auch über prädiktive Markeruntersuchungen für eine eventuelle zielgerichtete Therapie. In den meisten Fällen gelingt die Subtypisierung rein morphologisch aufgrund etablierter Kriterien und kann durch immunzytochemische Untersuchungen unterstützt werden. Zytologische Präparate müssen auch danach beurteilt werden, ob das Material für notwendige molekulare Markeranalysen ausreicht. Die Zytologie ist für prädiktive Markeranalysen genau so gut geeignet wie bioptisches Material. Gleichzeitig vorhandene Zytologien und Biopsien sollten sowohl für die Angabe des NSCLC-Subtyps als auch für die Entscheidung, welches Material für prädiktive Markeranalysen besser geeignet ist, miteinander verglichen werden. In diesem Übersichtsartikel diskutieren wir spezifische Aspekte der NSCLC-Subtypisierung und derzeit empfohlene prädiktive Markeranalysen.

Abstract

The diagnosis and treatment of non-small cell lung cancer (NSCLC) have been revolutionized over the last few years. Requirements for cytopathologists in lung cancer diagnosis have therefore changed. The general diagnostic category of NSLC is no longer sufficient. In addition cytological specimens need to be evaluated for adequacy regarding predictive marker analyses. Accurate NSCLC subtyping with a distinction of adenocarcinoma from squamous cell carcinoma is crucial for treatment decisions as the subtype will decide on the chemotherapy regimen and the choice of predictive marker analyses for targeted treatment. In the majority of cases, the subtype can be diagnosed by morphology alone. Cytology is equally well suited as biopsy specimens for the assessment of molecular predictive markers. The best results are achieved when both cytology and biopsy specimens are compared to choose the most appropriate specimen for morphological subtyping and molecular testing. In this paper, we discuss special issues of NSCLC subtyping and currently recommended predictive molecular marker analyses.

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Interessenkonflikt

Dr. S. Savic hat Vortragshonorare von Abbott Mol. erhalten und ist involviert in einem von Abbott Mol. finanzierten Forschungsprojekt.

Prof. L. Bubendorf hat an „Advisory-Board“-Meetings von Abbott Mol., Pfizer, AstraZeneca, Roche und Eli Lilly teilgenommen, Vortragshonorare von Abbott Mol., Pfizer, Astra Zeneca und Eli Lilly sowie finanzielle Forschungsunterstützung durch Abbott Mol. erhalten.

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Authors and Affiliations

  1. Institut für Pathologie, Universitätsspital Basel, Schönbeinstr. 40, 4031, Basel, Schweiz

    S. Savic, M.P. Bihl & L. Bubendorf

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  1. S. Savic
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  2. M.P. Bihl
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  3. L. Bubendorf
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Correspondence to S. Savic.

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Savic, S., Bihl, M. & Bubendorf, L. Nichtkleinzellige Lungenkarzinome. Pathologe 33, 301–307 (2012). https://doi.org/10.1007/s00292-012-1577-9

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  • DOI: https://doi.org/10.1007/s00292-012-1577-9

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