peran pemeriksaan molekular dalam diagnosis dan penatalaksanaan karsinoma...
TRANSCRIPT
Hasrayati Agustina
Peran Pemeriksaan Molekular
dalam Diagnosis dan
Penatalaksanaan Karsinoma Paru
Karsinoma Paru (Globocan, 2012)
Penyebab kematian utamaakibat kanker di dunia
Prognosis buruk : 5 ysr <15%
Deteksi dini (?)
Datang dengan stadium lanjut
Pengobatan efektif (-)
Pendahuluan
Pendahuluan
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diagnosis
klinis
radiologis Patologi
molekular
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Pemeriksaan Molekular
Imunohistokimia (IHC) dan imunositokimia (ICC)
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Mendeteksi protein spesifik
IHC : histopatologi/jaringan
ICC : sitologi / sel
Contoh:
TTF-1
Napsin A
P63
CK5/6
Contoh : Mendeteksi mutasi pada DNA
Sampel : jaringan, sitologi
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Mutasi gen : PCR-sequencing
Sampel : jaringan, sitologi deteksi kromosom denganhigh degree of sequence complementarity
Contoh : ALK
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Amplifikasi : FISH (flourescence insitu hybridisation)
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Peran pemeriksaan molekulardalam diagnosis dan
penatalaksanaan karsinoma paru
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Pemeriksaan
molekular
Membantu
menyelesaikan
Masalah diagnosis
Non small cell lung carcinoma (NSCLC) 80%
Adenocarcinoma
Squamous cell carcinoma
Large cell carcinoma
Small cell lung carcinoma (SCLC)
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Klasifikasi karsinoma Paru
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Adenocarcinoma vs squamous cell carcinoma
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Peran pemeriksaan molekular dalam diagnosis
karsinoma paru
Non small cell carcinoma vs small cell carcinoma
Neuroendocrine tumor : carcinoid, atypical carcinoid, small cell ca
Lung cancer therapy : personalized for individual patients
Understanding this new concept is essential for pathologists as they manage these specimens.
Recommended terminology for small biopsy and
cytology specimen
Adenocarcinoma (ADC)
Squamous cell carcinoma (SqCC)
Small cell carcinoma (SCC)
NSCLC favour adenocarcinoma
NSCLC favour squamous cell carcinoma
NSCLC-NOS
NSCLC possible Large cell neuroendocrine carcinoma
NSCLC with neuroendocrine morphology
NSCLC NOS could represent adenosquamous carcinoma
NSCLC NOS with spindle cell or giant cell carcinoma
Adenocarcinoma
SqCC
TTF-1
NSCLCC , favour adenocarcinoma
NSCLCC, favour Squamous cell carcinoma
p40
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Peran diagnostik : imunohistokimia
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Peran Diagnostik : imunohistokimia
New concept
the concept of minimal stains is maintained.
new approach is : recommending limited use of immunohistochemical and/or mucin stains for NSCLC-NOS cases classify for therapeutic purposes
The reason for use of minimal stains is to preserve tissue for molecular studies.
Cell block should be prepared
Neuroendocrine IHC marker should be performed only when suspected
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Peran pemeriksaan molekulardalam diagnosis dan
penatalaksanaan karsinoma paru
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Penatalaksanaan NSCLC
EGFR Berespon thd thyrosineKinase inhibitor
KRAS Resisten thd thyrosine Kinaseinhibitor
EML4-ALK
Berespon dengan Crizotinib
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Peran Pemeriksaan Molekular dalam Terapi
KESIMPULAN
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Pemeriksaan molekular memegang peranan penting dalamdiagnosis dan penatalaksanaan karsinoma paru
Imunohistokimia digunakan dalam membantu menegakkandiagnosis histopatologi
Pemeriksaan EGFR dan ALK penting dalam menentukan pilihanterapi
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