Naso Julia, Lo Ying-Chun, Sholl Lynette M
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.
Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
J Surg Oncol. 2023 Feb;127(2):244-257. doi: 10.1002/jso.27184.
The pathologic assessment of lung cancers provides essential guidance to the surgeon and oncologist who are considering the best treatment strategies for patients with both early and advanced-stage disease. The management of patients with lung cancer is predicated first and foremost on access to an accurate diagnosis, even when the sample size is limited, as is often the case with use of modern, minimally invasive sampling techniques. Once the diagnosis and disease stage are established, predictive biomarker testing may be essential, particularly for those patients with nonsmall cell lung carcinoma (NSCLC) being considered for immunotherapy or genomic biomarker-driven targeted therapy. This review will discuss the best practices for the diagnosis of NSCLC using morphology and immunohistochemistry, thus providing the surgeon with needed information to understand and critically evaluate pathology reports. Controversial and evolving topics including tumor spread through airspaces, evaluation of multiple tumors, and staging based on invasive tumor size will be addressed. Clinical genomic profiling in NSCLC is driven by published guidelines and reflects evidence based on clinical trials and regulatory approvals. In this fast-moving space, surgeons should be aware of the critical immunohistochemical and genomic biomarkers that drive systemic therapy decisions and anticipate when such testing will be required, both to ensure adequate sampling and to advise the pathologist when tumor material will be required for biomarker analysis. The basic approaches to and sample requirements for molecular biomarker testing will be addressed. As biomarker testing moves exclusively from advanced-stage patients into earlier stage disease, the surgeon should be aware of the relevant markers and work with the pathologist and oncologist to ensure that this information is available to facilitate timely access to therapies not just in the advanced setting, but in consideration of neoadjuvant and adjuvant care.
肺癌的病理评估为外科医生和肿瘤学家提供了重要指导，他们需要为早期和晚期肺癌患者考虑最佳治疗策略。肺癌患者的治疗首先基于准确的诊断，即使样本量有限，现代微创采样技术的使用往往就是这种情况。一旦确定诊断和疾病分期，预测性生物标志物检测可能至关重要，特别是对于那些考虑接受免疫治疗或基因组生物标志物驱动的靶向治疗的非小细胞肺癌（NSCLC）患者。本综述将讨论使用形态学和免疫组织化学诊断NSCLC的最佳实践，从而为外科医生提供必要信息，以理解和严格评估病理报告。还将讨论有争议和不断发展的主题，包括肿瘤通过气腔扩散、多原发肿瘤评估以及基于浸润性肿瘤大小的分期。NSCLC的临床基因组分析由已发表的指南驱动，并反映基于临床试验和监管批准的证据。在这个快速发展的领域，外科医生应了解驱动全身治疗决策的关键免疫组织化学和基因组生物标志物，并预测何时需要进行此类检测，既要确保足够的采样，又要在需要肿瘤材料进行生物标志物分析时告知病理科医生。还将讨论分子生物标志物检测的基本方法和样本要求。随着生物标志物检测仅从晚期患者扩展到早期疾病，外科医生应了解相关标志物，并与病理科医生和肿瘤学家合作，以确保获得这些信息，不仅便于在晚期情况下及时获得治疗，还能考虑新辅助和辅助治疗。
