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Der Nuklearmediziner 2021; 44(01): 27-34
DOI: 10.1055/a-1132-9619
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Gewebebasierte Diagnostik des Lungenkarzinoms – Morphologie und molekulare Diagnostik

Tissue-based diagnostics of lung carcinoma – morphology and molecular diagnostics
Thomas Mairinger
Inst.f. Gewebediagnostik am MVZ am Helios Klinikum Emil von Behring, Berlin
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Zusammenfassung

Die gewebebasierte Diagnostik des Lungenkarzinoms hat in der letzten Zeit mit der Einführung individualisierter Therapiemöglichkeiten an Bedeutung gewonnen. Die Basis der Diagnostik ist nach wie vor die lichtmikroskopische Beurteilung von histologischen Schnitten. Die Morphologie und das klinische Staging sind wegweisend für die weitere leitliniengerechten Therapie im Rahmen der sogenannten „individualisierten Therapie“ oder „Präzisionsmedizin“, bei der gezielt Veränderungen in intrazellulären Signalkaskaden therapeutisch beeinflusst werden.

Neben dem Eingriff in diese Signalkaskaden ist ein weiterer therapeutischer Ansatz der Versuch, mittels der Immuncheckpoint-Inhibitoren tumorimmunologische Reaktionen des körpereigenen Immunsystems zu initiieren bzw. zu ermöglichen. Die Stratifizierung von für diese Therapie geeigneten Patientengruppen erfolgt über den gewebebasierten immunhistochemischen Nachweis der entsprechenden membranösen Rezeptorexpression auf Tumor- oder Immunzellen.

Aus pathohistologischer Sicht spielen prädiktiv-diagnostisch sowohl Überexpression von Rezeptoren, als auch andere genetische und epigenetische Veränderungen (z. B. Inversionen, Translokationen, Methylierung etc.) in den Tumorzellen eine richtungsweisende Rolle.

Abstract

Tissue-based diagnostics of lung cancer has recently gained importance with the introduction of individualized therapy options. The basis of diagnostics is still the light microscopic evaluation of histological sections. The morphology and clinical staging point the way for further guideline-based therapy within the framework of so-called "individualized therapy" or "precision medicine", in which targeted changes in intracellular signaling cascades are therapeutically influenced.

In addition to interfering with these signaling cascades, another therapeutic approach is the attempt to initiate or enable tumor immunological responses of the body's own immune system by means of immune checkpoint inhibitors. Stratification of patient groups suitable for this therapy is performed by tissue-based immunohistochemical detection of the corresponding membranous receptor expression on tumor cells or immune cells.

From a pathohistological point of view, overexpression of receptors as well as other genetic and epigenetic alterations (e. g. inversions, translocations, methylation, etc.) in tumor cells play a predictive-diagnostic role.

Schlüsselwörter

Lungenkarzinom - Gewebediagnostik - Morphologie - Staging

Keywords

Lung cancer - histology - morphology - staging


Publication History

Article published online:
08 April 2021

© 2021. Thieme. All rights reserved.

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