ESMO E-Learning: Diagnostic Work Up in NSCLC and the Importance of Optimal Tissue Management in the Era of Personalised Medicine

Learning Objectives

  • To enhance knowledge of diagnostic work up in patients with advanced non-small cell lung cancer at histology and molecular pathology levels
  • To provide general recommendations for obtaining adequate tumour tissue, handling tumour tissue, and using tumour tissue
  • To emphasise on strategies for improving management of tumour biopsy samples
Title Duration Content CME Points CME Test
Diagnostic Work Up in NSCLC and the Importance of Optimal Tissue Management in the Era of Personalised Medicine 22 min. 41 slides 1 Take Test
felip enriqueta
Enriqueta Felip
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In non-small-cell lung cancer (NSCLC) the determination of histologic subtype and molecular Predictive markers are standard of care. The optimal management of biopsy specimens is needed to avoid repeating biopsies. In addition, the increased diagnostic demand dictates that the amount of tumour material obtained for analysis should be maximised in order to reduce the need for additional invasive sampling procedures.

Specific subtyping of NSCLC is necessary for therapeutic decision-making. Successful cyto-histologic diagnosis depends extensively on the correct methodology for obtaining and processing/preserving the samples to be sent to the pathology laboratory. In tumours without clear differentiation by routine light microscopy, special stains should be used. However, limited diagnostic work up is advisable to preserve the maximum amount of tissue for molecular testing.

This E-Learning module deals with different techniques for obtaining adequate lung tumour tissue and provides general recommendations for handling and using tumour tissues. It argues that accurate and relevant clinical information must be available for pathologists, who have a key role in the treatment decision. The module also underlines that institutions should develop their own multidisciplinary tissue management strategy to obtain specimens and process them. Emphasis should be placed on the need for optimal tissue collection.

Diagnostic work up includes standard morphologic stains, in the absence of definitive subtyping with morphologic criteria, limited use of Immunohistochemistry (IHC) is recommended. This module advises on best IHC utilisation and how to perform molecular predictive testing appropriately. In addition, it covers genetic alterations in lung adenocarcinoma. The module is authored by a medical oncologist with a good grasp of knowledge on pathology issues. The intention is to bring these issues closer to clinicians involved in lung cancer diagnosis, treatment and follow-up.

Diagnosis which incorporates molecular testing should be provided in an accurate and timely way. Close collaboration and communication among professionals is essential as is the development of a consensus to establish guidelines for which genetic testing is required. Personalised medicine in lung cancer is fast evolving and the author of this module advocates that for new potential targets, rapid implementation of their determinations in clinical practice is needed.

Last update: 15 April 2013

The author has reported no conflict of interest.