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Molekularpathologische Diagnostik in der Zytopathologie des nichtkleinzelligen Lungenkarzinoms

Standardisierung der Materialprozessierung

Molecular pathological diagnosis in cytopathology of non-small-cell lung cancer

Standardization of specimen processing

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Zusammenfassung

Hintergrund

Personalisierte Therapien werden zunehmend zum Standard in der Behandlung des nichtkleinzelligen Lungenkarzinoms. Der Nachweis entsprechender genetischer Alterationen erfordert eine hohe Kompetenz im Umgang mit unterschiedlichen Zell- und Gewebeproben. Eine große Herausforderung stellt die meist geringe Menge an verfügbarem Untersuchungsmaterial dar. Bis dato gibt es allerdings nur wenige standardisierte und evidenzbasierte Empfehlungen bezüglich der Materialprozessierung, der Analyse und der Befundung.

Material und Methode

Um eine Basis für standardisierte prädiktive Analysen in der Zytopathologie zu schaffen, wurden unterschiedliche Vorgehensweisen in der Materialprozessierung und der prädiktiven Diagnostik diskutiert, bewertet sowie Konzepte und Strategien für eine qualitätsoptimierte Diagnostik erarbeitet.

Ergebnisse und Diskussion

Die prädiktive Diagnostik in der Zytologie ist grundsätzlich an Ausstrich-, Zytozentrifugenpräparaten und Zellblöcken möglich. Die zytologischen Proben sollten mit möglichst minimalem Zellverbrauch aufgearbeitet werden, um weiteres Material für prädiktive Analysen zu erhalten. An zytologischem Material sind alle prädiktiven Analysen zuverlässig durchführbar, sodass nicht auf histologisches Material zurückgegriffen werden muss. Zytopathologie ist unter diesen Voraussetzungen ein wichtiger Partner in der multidisziplinären und zunehmend komplexer werdenden Betreuung von Lungenkrebspatienten.

Abstract

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.

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Danksagung

Die Autoren danken Herrn Professor Dr. F.J.F. Herth, Heidelberg, für die Überarbeitung der Tabellen aus pneumologischer Sicht.

Interessenkonflikt

Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehungen hin: Das Expertentreffen (Teilnahme von L.B., S.G., A.M.-H., M.H., K.J., U.L., I.P., P.A.S.) und das Erstellen des Manuskripts (durch A.W.) wurden durch AstraZeneca unterstützt.

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Authors and Affiliations

  1. Institut für Pathologie, Universität Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Deutschland

    A. Warth

  2. Institut für Pathologie, Universität Basel, Basel, Deutschland

    L. Bubendorf

  3. Robert-Koch Klinik, Klinikum St. Georg Leipzig, Leipzig, Deutschland

    S. Gütz

  4. Institut für Pathologie, Asklepios Fachkliniken München-Gauting, München, Deutschland

    A. Morresi-Hauf

  5. Institut für Pathologie, Charité, Berlin, Deutschland

    M. Hummel

  6. Zentrum für Pathologie, Klinikum Bremen Mitte, Bremen, Deutschland

    K. Junker

  7. Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Deutschland

    U. Lehmann

  8. Institut für Pathologie, Universität Jena, Jena, Deutschland

    I. Petersen

  9. Sektion Pneumopathologie, Institut für Pathologie, Universität Heidelberg, Heidelberg, Deutschland

    P.A. Schnabel

  10. Arbeitsgemeinschaft Pneumopathologie der Deutschen Gesellschaft für Pathologie, -, -

    A. Warth, L. Bubendorf, A. Morresi-Hauf, K. Junker, I. Petersen & P.A. Schnabel

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  1. A. Warth
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  2. L. Bubendorf
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  9. P.A. Schnabel
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Correspondence to A. Warth.

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Warth, A., Bubendorf, L., Gütz, S. et al. Molekularpathologische Diagnostik in der Zytopathologie des nichtkleinzelligen Lungenkarzinoms. Pathologe 34, 310–317 (2013). https://doi.org/10.1007/s00292-013-1764-3

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  • DOI: https://doi.org/10.1007/s00292-013-1764-3

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