Mayo Clinic, Rochester, Minnesota, USA.
Curr Opin Pulm Med. 2010 Jul;16(4):315-20. doi: 10.1097/MCP.0b013e328337f938.
Considerable advances in genomics, transcriptomics and proteomics have in the recent years transformed our understanding of the molecular mechanisms involved in the pathogenesis of lung cancer and are in the process of revolutionizing our approach to its diagnosis and treatment. Although these techniques have traditionally been described in the context of large volume biopsies from surgically resected tumors, significant technical advances allow their application to smaller samples obtained bronchoscopically, often the only samples available in advanced lung cancer.
Recent data support the use of advanced molecular techniques as an adjunct to conventional histologic examinations of bronchoscopy specimens in the following situations: early diagnosis and screening of nonsmall cell lung cancer by fluorescent in-situ hybridization techniques in particular; accurate histologic diagnosis via novel immunohistochemistry markers; and prognosis and prediction of response to targeted and conventional chemotherapeutic agents.
Molecular biology techniques are increasingly applied to smaller biopsy specimens obtained via bronchoscopy, allowing for their use in advanced, unresectable nonsmall cell lung cancer. Although these techniques have not yet entered the clinical practice arena, they will likely become an unavoidable complement to conventional morphologic examinations and allow for individualized diagnostic and therapeutic approach to lung-cancer patients.
近年来，基因组学、转录组学和蛋白质组学的巨大进展改变了我们对肺癌发病机制中涉及的分子机制的理解，并正在彻底改变我们对其诊断和治疗的方法。尽管这些技术传统上是在手术切除肿瘤的大体积活检的背景下描述的，但重大的技术进步允许将其应用于支气管镜获得的较小样本，通常在晚期肺癌中只有这些样本可用。
最近的数据支持将先进的分子技术作为支气管镜标本常规组织学检查的辅助手段，特别是在以下情况下：通过荧光原位杂交技术进行非小细胞肺癌的早期诊断和筛查；通过新型免疫组织化学标志物进行准确的组织学诊断；以及对靶向和常规化疗药物的预后和反应预测。
分子生物学技术越来越多地应用于通过支气管镜获得的较小活检标本，从而可将其用于晚期不可切除的非小细胞肺癌。尽管这些技术尚未进入临床实践领域，但它们很可能成为对常规形态学检查的不可或缺的补充，并允许对肺癌患者进行个体化的诊断和治疗方法。
