Lung Cancer in the Era of Targeted Therapy: A Cytologist's Perspective

Abstract

Context.-The diagnosis and treatment of non-small cell lung cancer have changed dramatically in the past few years. The discovery of activating mutations in the tyrosine kinase domain of the epidermal growth factor receptor and the use of drugs that successfully target those mutations are among the key advances that have led to a shift in the practice of oncology and pathology, with perhaps the greatest effect on the field of cytology.Objectives.-To present the perspective of a practicing thoracic pathologist and cytopathologist on the developments that have changed practice and to place those changes in a broader context. Data Sources.-Literature review, studies undertaken or participated in by the author, and personal experience.Conclusions.-Cytologists are in an ideal position to influence appropriate testing and treatment in the era of targeted therapy. Lung pathology has led the way in the era of targeted therapy, in no small part due to cytology.

Increased utilization, verification, and clinical implications of immunocytochemistry: Experience in a northern New England hospital

“…These sites reflect the most common diagnostic questions requiring the use of ICC, which include but are not limited to: definitive classification of nonsmall cell lung carcinoma in fine-needle aspirations (FNAs) as adenocarcinoma versus squamous cell carcinoma [7][8][9] ; distinguishing lung adenocarcinoma and metastatic tumors from malignant mesothelioma in pleural fluids 10,11 ; identification of lymphoma in lymph nodes; and work up of an unknown primary in tumors metastatic to the liver. These sites reflect the most common diagnostic questions requiring the use of ICC, which include but are not limited to: definitive classification of nonsmall cell lung carcinoma in fine-needle aspirations (FNAs) as adenocarcinoma versus squamous cell carcinoma [7][8][9] ; distinguishing lung adenocarcinoma and metastatic tumors from malignant mesothelioma in pleural fluids 10,11 ; identification of lymphoma in lymph nodes; and work up of an unknown primary in tumors metastatic to the liver.…”

Diagnosis of anaplastic lymphoma kinase rearrangement in cytological samples through a fluorescence in situ hybridization–based assay: Cytological smears versus cell blocks

“…Approximately 70% of lung cancer diagnoses are based on small biopsy specimens or cytological samples, with most patients being at an advanced stage . However, only in 2004 were cytological specimens belatedly included in the World Health Organization lung cancer classification system .…”

“…Approximately 70% of lung cancer diagnoses are based on small biopsy specimens or cytological samples, with most patients being at an advanced stage. 1 However, only in 2004 were cytological specimens belatedly included in the World Health Organization lung cancer classification system. 2 The International Association for the Study of Lung Cancer, the American Thoracic Society, and the European Respiratory Society have provided a new standardized terminology and diagnostic criteria for small biopsy specimens and cytological samples.…”

Feasibility of quantitative parameters of dynamically enhanced patterns of spiral computed tomography scanning integrated into tumour progression before targeted treatment of non‐small cell lung cancer

“…Recently, targeted therapy has become an important and novel method for the treatment of cancer with the development of cytology, including NSCLC . Previous finding with spiral CT and quantitative parameters of dynamically enhanced patterns of spiral CT scanning, such as enhanced peak values, peak time of tumour enhancement, ratio of tumour mass and enhanced aorta peak value and perfusion value of blood flow, has enriched roles of spiral CT in the detection and treatment of NSCLC .…”

“…4 Accordingly, as computed tomography (CT) could display tumour angiogenesis, spiral CT was superior to chest radiography in the screening and detection of lung cancer with the rapid progress of CT. 5 Recently, targeted therapy has become an important and novel method for the treatment of cancer with the development of cytology, including NSCLC. 6 Previous finding with spiral CT and quantitative parameters of dynamically enhanced patterns of spiral CT scanning, such as enhanced peak values, peak time of tumour enhancement, ratio of tumour mass and enhanced aorta peak value and perfusion value of blood flow, has enriched roles of spiral CT in the detection and treatment of NSCLC. 7 Although spiral CT is a promising diagnostic tool for NSCLC, the potential usefulness of spiral CT scanning for confirming the time of tumour progression (TTP) before targeted treatment of NSCLC has not been explored.…”