Akciğer Kanserlerinde Patoloji
Özet
Patoloji, akciğer kanserlerinin tanımlanması, histolojik sınıflandırılması ve tedavi yönetiminde kritik bir rol oynar. Tanı süreci preanalitik fiksasyon, analitik laboratuvar değerlendirmesi ve postanalitik arşivleme olmak üzere üç temel evreden oluşmaktadır. Sınırlı biyopsiler ve cerrahi rezeksiyonlar örnekleme çeşitliliğini sağlarken, operasyon sırasında yapılan intraoperatif konsültasyon (frozen) cerrahi yönü belirlemede hayati öneme sahiptir ancak teknik limitasyonları mevcuttur. Akciğer tümörleri benign ve adenokarsinom, skuamöz hücreli karsinom ile küçük hücreli karsinom gibi malign epitelyal neoplaziler olarak sınıflandırılır. Günümüzde immünohistokimyasal belirteçler (TTF-1, p40) ve prediktif testler (PD-L1, ALK, ROS-1), moleküler patoloji algoritmalarıyla birleşerek hastaya özgü bireyselleştirilmiş hedefe yönelik tedavilerin ve immünoterapilerin uygulanmasına olanak tanımaktadır.
Pathology plays a critical role in the identification, histological classification, and treatment management of lung cancers. The diagnostic process consists of three main stages: preanalytical fixation, analytical laboratory evaluation, and postanalytical archiving. While limited biopsies and surgical resections ensure sampling diversity, intraoperative consultation (frozen section) performed during surgery is vital for guiding the operation, despite its technical limitations. Lung tumors are classified into benign lesions and malignant epithelial neoplasms, such as adenocarcinoma, squamous cell carcinoma, and small cell carcinoma. Today, immunohistochemical markers (TTF-1, p40) and predictive assays (PD-L1, ALK, ROS-1), combined with molecular pathology algorithms, enable the implementation of patient-specific, individualized targeted therapies and immunotherapies.
Referanslar
Travis W, Brambilla E, … MN… of P and, 2013 undefined. specimens: implications of the 2011 International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification. meridian.allenpress.com [Internet]. [cited 2022 Jan 1]; Available from: https://meridian.allenpress.com/aplm/article-abstract/137/5/685/132524
White VA, Trotter MJ. Intraoperative consultation/final diagnosis correlation: relationship to tissue type and pathologic process. Arch Pathol Lab Med [Internet]. 2008 Jan [cited 2021 Dec 20];132(1):29–36. Available from: https://pubmed.ncbi.nlm.nih.gov/18181670/
Borczuk AC. Challenges of Frozen section in thoracic pathology lepidic lesions, limited resections, and margins. Archives of Pathology and Laboratory Medicine. 2017 Jul 1;141(7):932–9.
Mukhopadhyay S, Sudarshan M. Spread through airspaces (STAS) on frozens: too much, too soon. Mod Pathol [Internet]. 2021 [cited 2021 Dec 20]; Available from: https://pubmed.ncbi.nlm.nih.gov/34702995/
Zhou F, Villalba JA, Sayo TMS, Narula N, Pass H, Mino-Kenudson M, et al. Assessment of the feasibility of frozen sections for the detection of spread through air spaces (STAS) in pulmonary adenocarcinoma. Mod Pathol [Internet]. 2021 [cited 2021 Dec 20]; Available from: https://pubmed.ncbi.nlm.nih.gov/34326485/
Fan M, Lin Y, Oncology LLJ of T, 2014 undefined. Multiple pulmonary chondroid hamartoma. jto.org [Internet]. [cited 2022 Jan 1]; Available from: https://www.jto.org/article/S1556-0864(15)30342-7/abstract
Moran C, Suster S, … MK pathology: an official journal of the, 1994 undefined. Endobronchial lipomas: a clinicopathologic study of four cases. europepmc.org [Internet]. [cited 2022 Jan 1]; Available from: https://europepmc.org/article/med/8008745
Rao N, Moran C, Manual SSCG, 2013 undefined. Tumors of the lungs and pleura. Springer [Internet]. [cited 2022 Jan 1]; Available from: https://link.springer.com/chapter/10.1007/978-3-642-34516-6_3
Roshkovan L, Thompson J, … SKJ of T, 2020 undefined. Alveolar adenoma of the lung: multidisciplinary case discussion and review of the literature. ncbi.nlm.nih.gov [Internet]. [cited 2022 Jan 1]; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7711389/
Tsao M, Nicholson A, Maleszewski J, … AMJ of T, 2022 undefined. Introduction to 2021 WHO Classification of Thoracic Tumors. jto.org [Internet]. [cited 2022 Jan 1]; Available from: https://www.jto.org/article/S1556-0864(21)03255-X/abstract
Ferone G, Lee MC, Sage J, Berns A. Cells of origin of lung cancers: lessons from mouse studies. Genes Dev [Internet]. 2020 [cited 2022 Jan 1];34(15–16):1017–32. Available from: https://pubmed.ncbi.nlm.nih.gov/32747478/
Anderson K, Heidinger B, … YCA journal of, 2017 undefined. Measurement Bias of Gross Pathologic Compared With Radiologic Tumor Size of Resected Lung AdenocarcinomasImplications for the T-Stage Revisions in the. academic.oup.com [Internet]. [cited 2022 Jan 1]; Available from: https://academic.oup.com/ajcp/article-abstract/147/6/641/3860302
Cha M, Lee H, Lee K, Jeong J, … JHTJ of thoracic, 2014 undefined. Micropapillary and solid subtypes of invasive lung adenocarcinoma: clinical predictors of histopathology and outcome. Elsevier [Internet]. [cited 2022 Jan 1]; Available from: https://www.sciencedirect.com/science/article/pii/S0022522313011422
Yoshizawa A, Motoi N, Riely G, … CSM, 2011 undefined. Impact of proposed IASLC/ATS/ERS classification of lung adenocarcinoma: prognostic subgroups and implications for further revision of staging based on. nature.com [Internet]. [cited 2022 Jan 1]; Available from: https://www.nature.com/articles/modpathol2010232
Moreira A, Ocampo P, Xia Y, … HZJ of T, 2020 undefined. A grading system for invasive pulmonary adenocarcinoma: a proposal from the International Association for the Study of Lung Cancer Pathology Committee. Elsevier [Internet]. [cited 2022 Jan 1]; Available from: https://www.sciencedirect.com/science/article/pii/S1556086420304688
Bishop JA, Teruya-Feldstein J, Westra WH, Pelosi G, Travis WD, Rekhtman N. p40 (ΔNp63) is superior to p63 for the diagnosis of pulmonary squamous cell carcinoma. Mod Pathol [Internet]. 2012 Mar [cited 2021 Dec 23];25(3):405–15. Available from: https://pubmed.ncbi.nlm.nih.gov/22056955/
Bodor JN, Boumber Y, Borghaei H. Biomarkers for immune checkpoint inhibition in non–small cell lung cancer (NSCLC). Cancer. 2020 Jan 15;126(2):260–70.
Hernandez A, Brandler TC, Chen F, Zhou F, Xia Y, Zhong J, et al. Scoring of programmed death-Ligand 1 immunohistochemistry on cytology cell block specimens in non–Small cell lung carcinoma an interobserver agreement study. American Journal of Clinical Pathology. 2020 Jun 27;154(4):517–24.
Paver EC, Cooper WA, Colebatch AJ, Ferguson PM, Hill SK, Lum T, et al. Programmed death ligand-1 (PD-L1) as a predictive marker for immunotherapy in solid tumours: a guide to immunohistochemistry implementation and interpretation. Pathology. 2021 Feb 1;53(2):141–56.
