Peran Pemeriksaan Molekular dalam Diagnosis dan Penatalaksanaan Karsinoma...

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

3

diagnosis

klinis

radiologis Patologi

molekular

4

Pemeriksaan Molekular

Imunohistokimia (IHC) dan imunositokimia (ICC)

5

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

6

Mutasi gen : PCR-sequencing

Sampel : jaringan, sitologi deteksi kromosom denganhigh degree of sequence complementarity

Contoh : ALK

7

Amplifikasi : FISH (flourescence insitu hybridisation)

8

Peran pemeriksaan molekulardalam diagnosis dan

penatalaksanaan karsinoma paru

9

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)

10

Klasifikasi karsinoma Paru

11

Adenocarcinoma vs squamous cell carcinoma

12

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

19

Peran diagnostik : imunohistokimia

20

21

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

23

Peran pemeriksaan molekulardalam diagnosis dan

penatalaksanaan karsinoma paru

24

Penatalaksanaan NSCLC

EGFR Berespon thd thyrosineKinase inhibitor

KRAS Resisten thd thyrosine Kinaseinhibitor

EML4-ALK

Berespon dengan Crizotinib

25

Peran Pemeriksaan Molekular dalam Terapi

KESIMPULAN

26

Pemeriksaan molekular memegang peranan penting dalamdiagnosis dan penatalaksanaan karsinoma paru

Imunohistokimia digunakan dalam membantu menegakkandiagnosis histopatologi

Pemeriksaan EGFR dan ALK penting dalam menentukan pilihanterapi

27