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Optimizing tissue sampling for the diagnosis, subtyping and molecular analysis of lung cancer

Amrit Koirala, MD
Interventional Radiologist, NCHRC

In recent years particularly since the start of personalized cancer therapy, the demand for molecular profiling of the patient’s tumor carries great importance. In advanced lung cancer patients, testing for epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK) gene rearrangements has become an essential component of clinical practice to select patients who are most likely to benefit from EGFR and ALK tyrosine kinase inhibitors, respectively. Likewise obtaining tissue specimens from metastatic tumors or from patients who develop resistance to initial effective therapies are essential for our understanding of the molecular basis of tumor progression and development of drug resistance. Sampling of tumor tissue that is representative and is adequate in quantity and quality for pathological diagnosis and genomic profiling is crucial. In this presentation, we will discuss factors that should be considered in obtaining and processing biopsy specimens to enable routine molecular analysis in lung cancer patients.

Changing role of Radiologist in Cancer Management
In yesteryears, the radiologist used to be a physician who adds value to the health care system solely by generating and interpreting diagnostic images. Advances in the diagnosis and treatment of cancer have achieved a significant increase in the general and disease-free survival of affected patients but have also increased the complexity of therapeutic decisions. The decision-making process requires agreement between the physicians involved in the management of these patients. Radiologists and particularly Interventional Radiologists must understand what other physicians expect and inform them about the usefulness of imaging modalities as well as radiologic therapeutic interventions.