Patología y Estudios Moleculares en el Cáncer de Pulmón de Células no Pequeñas (CPCNP): 2do consenso nacional de la sociedad panameña de oncología (SPO). (Mesa 3)

Alejandro Crismatt, I Barrera, K Gonzalez, A Crismatt


En la última década el diagnóstico histopatológico se ha vuelto un determinante importante para el tratamiento del cáncer de pulmón de células no pequeñas (CPCNP). Un número creciente de pacientes se benefician de terapias blancos dirigidas a alteraciones moleculares particulares (Mutaciones, genes de Fusión...etc.), por lo tanto, el diagnóstico preciso y las pruebas de laboratorio basadas en biomarcadores predictivos para la determinación de los pacientes que más probablemente respondan a las terapias blanco, representan un cambio en el paradigma diagnóstico del cáncer de pulmón y son ahora un estándar[1]. El diagnóstico histopatológico del cáncer de pulmón es un proceso de múltiples pasos que inicia con el diagnóstico morfológico para determinar el tipo histológico (refinado por la inmuno-histoquímica en los casos requeridos), seguido de la caracterización molecular del tumor.  La creciente complejidad del algoritmo diagnóstico representa nuevos retos para los pacientes con cáncer de pulmón, dentro de los cuales destaca la disponibilidad de suficiente tejido para realización de todas las pruebas moleculares. La mayoría de los CPCNP son diagnosticados en etapas avanzadas de la enfermedad, por lo que las grandes muestras de tumor (resección quirúrgica) se obtienen solo en unos pocos casos. Por lo tanto, es imperativo que toda adquisición de tejido tumoral se maximice para lograr realizar las pruebas moleculares requeridas. El rol del equipo multidisciplinario que incluye al neumólogo, radiólogo, patólogo, cirujano torácico y oncólogo es esencial para determinar el mejor abordaje de cada paciente[2,3].

[Pathology and Molecular Studies in Non Small Cell Lung Cancer (CPCNP): 2nd national consensus of the Panamanian Oncology Society (SPO).]

In the last decade, histopathological diagnosis has become an important determinant for the treatment of non-small cell lung cancer (NSCLC). A growing number of patients benefit from therapies targeting particular molecular alterations (Mutations, Fusion genes... etc.), thus accurate diagnosis and laboratory tests based on predictive biomarkers for the determination of patients who more likely to respond to target therapies, represent a change in the diagnostic paradigm of lung cancer and are now a standard[1]. The histopathological diagnosis of lung cancer is a multi-step process that begins with the morphological diagnosis to determine the histological type (refined by immunohistochemistry in the required cases), followed by the molecular characterization of the tumor. The increasing complexity of the diagnostic algorithm represents new challenges for patients with lung cancer, in which the availability of sufficient tissue for the realization of all molecular tests stands out. Most NSCLC are diagnosed in advanced stages of the disease, so large tumor samples (surgical resection) are obtained only in a few cases. Therefore, it is imperative that any acquisition of tumor tissue is maximized to achieve the required molecular tests. The role of the multidisciplinary team that includes the pulmonologist, radiologist, pathologist, thoracic surgeon and oncologist is essential to determine the best approach for each patient[2,3].

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