The Fingerland Department of Pathology, Charles University Faculty of Medicine and University Hospital, Hradec Králové, Czech Republic.
Department of Oncology, Specialised Hospital of St Zoerardus Zobor, Nitra, Slovakia.
BMC Cancer. 2018 Mar 9;18(1):269. doi: 10.1186/s12885-018-4023-4.
The introduction of targeted treatments for subsets of non-small cell lung cancer (NSCLC) has highlighted the importance of accurate molecular diagnosis to determine if an actionable genetic alteration is present. Few data are available for Central and Eastern Europe (CEE) on mutation rates, testing rates, and compliance with testing guidelines.
A questionnaire about molecular testing and NSCLC management was distributed to relevant specialists in nine CEE countries, and pathologists were asked to provide the results of EGFR and ALK testing over a 1-year period.
A very high proportion of lung cancer cases are confirmed histologically/cytologically (75-100%), and molecular testing of NSCLC samples has been established in all evaluated CEE countries in 2014. Most countries follow national or international guidelines on which patients to test for EGFR mutations and ALK rearrangements. In most centers at that time, testing was undertaken on request of the clinician rather than on the preferred reflex basis. Immunohistochemistry, followed by fluorescent in situ hybridization confirmation of positive cases, has been widely adopted for ALK testing in the region. Limited reimbursement is a significant barrier to molecular testing in the region and a disincentive to reflex testing. Multidisciplinary tumor boards are established in most of the countries and centers, with 75-100% of cases being discussed at a multidisciplinary tumor board at specialized centers.
Molecular testing is established throughout the CEE region, but improved and unbiased reimbursement remains a major challenge for the future. Increasing the number of patients reviewed by multidisciplinary boards outside of major centers and access to targeted therapy based on the result of molecular testing are other major challenges.
针对非小细胞肺癌（NSCLC）亚组的靶向治疗的引入凸显了准确的分子诊断对于确定是否存在可操作的遗传改变的重要性。关于突变率、检测率以及对检测指南的遵循情况，中欧和东欧（CEE）地区的数据很少。
向九个 CEE 国家的相关专家分发了一份关于分子检测和 NSCLC 管理的问卷，并要求病理学家提供过去一年 EGFR 和 ALK 检测的结果。
非常高比例的肺癌病例通过组织学/细胞学确诊（75-100%），并且 2014 年在所有评估的 CEE 国家均已建立了 NSCLC 样本的分子检测。大多数国家都遵循国家或国际指南，确定哪些患者需要检测 EGFR 突变和 ALK 重排。在大多数中心，当时的检测是根据临床医生的要求进行的，而不是首选的反射式基础。免疫组织化学，随后对阳性病例进行荧光原位杂交确认，已在该地区广泛用于 ALK 检测。有限的报销是该地区分子检测的一个重大障碍，也是对反射式检测的抑制因素。多学科肿瘤委员会在大多数国家和中心建立，75-100%的病例在专门中心的多学科肿瘤委员会上进行讨论。
分子检测在 CEE 地区已经建立，但改进和无偏见的报销仍然是未来的主要挑战。增加多学科委员会审查的患者数量以及根据分子检测结果获得靶向治疗也是其他主要挑战。
