Faculty of Medicine in Novi Sad, University of Novi Sad, Hajduk Veljkova 3, 21137 Novi Sad, Serbia.
Institute for Pulmonary Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia.
Medicina (Kaunas). 2023 Sep 27;59(10):1723. doi: 10.3390/medicina59101723.
: Treatment of advanced lung cancer (LC) has become increasingly personalized over the past decade due to an improved understanding of tumor molecular biology and antitumor immunity. The main task of a pulmonologist oncologist is to establish a tumor diagnosis and, ideally, to confirm the stage of the disease with the least invasive technique possible. : The paper will summarize published reviews and original papers, as well as published clinical studies and case reports, which studied the role and compared the methods of invasive pulmonology diagnostics to obtain adequate tumor tissue samples for molecular analysis, thereby determining the most effective molecular treatments. : Bronchoscopy is often recommended as the initial diagnostic procedure for LC. If the tumor is endoscopically visible, the biopsy sample is susceptible to molecular testing, the same as tumor tissue samples obtained from surgical resection and mediastinoscopy. The use of new sampling methods, such as cryobiopsy for peripheral tumor lesions or cytoblock obtained by ultrasound-guided transbronchial needle aspiration (TBNA), enables obtaining adequate small biopsies and cytological samples for molecular testing, which have until recently been considered unsuitable for this type of analysis. During LC patients' treatment, resistance occurs due to changes in the mutational tumor status or pathohistological tumor type. Therefore, the repeated taking of liquid biopsies for molecular analysis or rebiopsy of tumor tissue for new pathohistological and molecular profiling has recently been mandated. : In thoracic oncology, preference should be given to the least invasive diagnostic procedure providing a sample for histology rather than for cytology. However, there is increasing evidence that, when properly processed, cytology samples can be sufficient for both the cancer diagnosis and molecular analyses. A good knowledge of diagnostic procedures is essential for LC diagnosing and treatment in the personalized therapy era.
: 由于对肿瘤分子生物学和抗肿瘤免疫的深入了解，过去十年中，晚期肺癌（LC）的治疗已变得越来越个体化。肺肿瘤学家的主要任务是建立肿瘤诊断，并尽可能使用微创技术来确定疾病的分期。 : 本文将总结已发表的综述和原始论文，以及已发表的临床研究和病例报告，这些研究探讨了侵袭性肺病学诊断的作用，并比较了获取足够的肿瘤组织样本进行分子分析的方法，从而确定最有效的分子治疗方法。 : 支气管镜检查通常被推荐作为 LC 的初始诊断程序。如果肿瘤在镜下可见，活检样本可进行分子检测，与手术切除和纵隔镜检查获得的肿瘤组织样本相同。新的采样方法的使用，例如用于外周肿瘤病变的冷冻活检或超声引导下经支气管针吸活检（TBNA）获得的细胞块，使获得足够的小活检和细胞学样本进行分子检测成为可能，这些样本在不久前被认为不适合进行这种类型的分析。在 LC 患者的治疗过程中，由于肿瘤突变状态或病理组织学肿瘤类型的变化，会出现耐药性。因此，最近已要求反复进行分子分析的液体活检或肿瘤组织的重新活检以进行新的病理组织学和分子分析。 : 在胸肿瘤学中，应优先选择提供组织学样本而不是细胞学样本的微创诊断程序。然而，越来越多的证据表明，在适当处理的情况下，细胞学样本足以进行癌症诊断和分子分析。对于个体化治疗时代的 LC 诊断和治疗，良好的诊断程序知识至关重要。
