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Current Concepts in the Diagnosis of Lung Cancer

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Current Concepts in the Diagnosis of Lung Cancer

  1. 1. Current Concepts in the Diagnosis of Lung Cancers BY THEINTERNATIONAL ASSOCIATION FOR THE STUDY OF LUNG CANCER ADELAIDE CONVENTION CENTER ADELAIDE, SOUTH AUSTRALIA, AUSTRALIA FELIPE S TEMPLO JR., MD
  2. 2. PART I: ANATOMICAL PATHOLOGY NEEDS
  3. 3. PHC data (1998-2003). Templo FS, Orillaza MA, Tan CD (2003)Correct specific diagnosis in 30% (38% SCC and 23% AdenoCA)NSCLC-NOS is 62% (22.6% SCC and 37.7% AdenoCa)Incorrect specific diagnosis is 7.5% (10% AdenoCA and 4.7% SCC)
  4. 4. LEPIDIC ACINARPAPILLARY MICROPAPILLARY SOLID WITH MUCIN
  5. 5. PART II: MOLECULAR PATHOLOGY NEEDS
  6. 6. Testing for research purposes only
  7. 7. 2010 NON-SMALL CELL LUNG CARCINOMAS NON-SQUAMOUS CELL CA*SQUAMOUS CELL CA MUTATION TESTING EGFR :exons 19 &21; NO TESTING exons 18-21 UNLESS REQUESTED FISH KRAS :(exon 2/codon12-13 BY THE ONCOLOGIST ALK (OPTIONAL)
  8. 8. 22012
  9. 9. 5 unstained sections
  10. 10. 5 unstained slides
  11. 11. KRAS MUTATION TESTING
  12. 12. EML-4-ALK TESTING Positive for translocation Negative for translocation
  13. 13. Laser microdissection
  14. 14. GENERAL RECOMMENDATIONS FOR EGFR/KRAS TESTING: Blocks (formalin-fixed, paraffin-embedded) are highly recommended for optimal testing. Testing can be performed on primary tumor or a site of metastasis 1) FFPE tissue block containing 20% to 25% tumor OR 2) 3-4 precut unstained slides from paraffin block in 5 micron sections and one H&E reference slide (manual microdissection) Use special slides for laser microdissection (7 micron) FFPE blocks from surgical resections, excisional biopsies, fine needle aspirates (FNA) and biopsy, core needle biopsies, cell blocks (pleural effusions, ascites and FNAs) and bone marrow. A minimum of 300-500 viable tumor cells are required.
  15. 15. EXPERIENCE AT ST VINCENT’S HOSPITAL
  16. 16. TISSUE COLLECTION/FIXATION24 HOURS BIOPSY FIXATION/TISSUE PROCESSING PATHOLOGIST’S REVIEW AND 1-2 REPORT PATHOLOGYWORKINGDAYSEXCEPT DECISION FOR EGFR MUTATION ANALYSIS,IHC TUMOR CONTENT REVIEWED TUMOR MICRODISSECTION IF NEEDED MOLECULAR TESTING 5-7 WORKING EGFR MUTATION TESTING DAYS FINAL FINAL REPORT WITH TUMOR HISTOLOGY REPORT AND MUTATION RESULTS
  17. 17. NEW CANDIDATE PREDICTIVE MARKERS HER2 RAF PI3KCA–AKT–mTOR pathway C-MET Insulin-like growth factor (IGF1R) Fibroblastic growth factor receptor 1 (FGFR1) and discoidin domain receptor family, member 2 (DDR2) Target molecules for chemotherapeutic agents
  18. 18. Questions?1. Which Patients Should Be Tested for the Presence of These Mutations to Determine Their First-line Therapy Options? First, what is the chance of an activating mutation being present? Second, what is the cost of testing? How should testing be performed? Which mutations of the EGFR are clinically significant? 2011 by American Society of Clinical Oncology.
  19. 19. Questions?2. Should Patients with Less than 10 Packs/Year Smoking History and Non-squamous Histology Be Empirically Treated with Oral EGFR TKIs in the Absence of EGFR Testing?3. Should KRAS Testing Be Used to Deny Patients Therapy with Oral EGFR TKI Inhibitors?4. Is There a Role for EGFR FISH Testing When Considering the Use of First-generation Oral EGFR TKIs? 2011 by American Society of Clinical Oncology.
  20. 20. Questions?5. How Common Is ALK?6. What Are the Key Clinical Features Associated with ALK?7. Should All Patients with NSCLC Be Tested for ALK? 2011 by American Society of Clinical Oncology
  21. 21. Questions?8. Should Patients with EGFR or KRAS Mutant Lung Cancer be Tested for ALK?9. What Is the Diagnostic Test of Choice for ALK?10. Are There Other Diagnostic Modalities for ALK? 2011 by American Society of Clinical Oncology
  22. 22. Copyright © 2012 by theInternational Association for the Studyof Lung Cancer
  23. 23. ACKNOWLEDGEMENT1. DR. LINDY CLARKE, FRCPA The Prince Charles Hospital Brisbane, Queensland, Australia2. DR. PRUDENCE RUSSELL, FRCPA St. Vincent’s Hospital and Peter McCallum Cancer Centre Melbourne, Victoria, Australia3. Ms. KAREN LATHER The Australian Lung Foundation Adelaide, South Australia, Australia Copyright © 2012 by the International Association for the Study of Lung Cancer

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