rpmjResearch'n Practical Medicine JournalResearch and Practical Medicine Journal2410-1893"QUASAR", LLC10.17709/2409-2231-2020-7-3-5rpmj-588Research ArticleОбзорыReviewМорфологическая и молекулярно-генетическая диагностика рака легкого: методики и проблемыMorphological and molecular genetic diagnosis of lung cancer: methods and problemshttps://orcid.org/0000-0002-4304-0139УсачевВ. С.UsachevV. S.

Усачев Владимир Сергеевич – научный сотрудник отделения лучевого и хирургического лечения заболеваний торакальной области

249035, г. Обнинск, ул. Королева, д. 4

SPIN: 1329-7915

AuthorID: 901529

Scopus Author ID: 57200716739

Vladimir S. Usachev – researcher of the department of radiation and surgical treatment of thoracic region diseases

4 Korolev str., Obninsk 249036

SPIN: 1329-7915

AuthorID: 901529

Scopus Author ID: 57200716739

doc-vova@mail.ruhttps://orcid.org/0000-0003-3782-7338СмоленовЕ. И.SmolenovE. I.

Смоленов Евгений Игоревич – научный сотрудник отделения лучевого и хирургического лечения заболеваний торакальной области

249035, г. Обнинск, ул. Королева, д. 4

SPIN: 6376-2673

AuthorID: 808954

Evgeny I. Smolenov – researcher of the department of radiation and surgical treatment of thoracic region diseases

4 Korolev str., Obninsk 249036

SPIN: 6376-2673

AuthorID: 808954

https://orcid.org/0000-0001-5352-9248РагулинЮ. А.RagulinYu. A.

Рагулин Юрий Александрович – к.м.н., ведущий научный сотрудник отделения лучевого и хирургического лечения заболеваний торакальной области

249035, г. Обнинск, ул. Королева, д. 4

SPIN: 6453-6594

AuthorID: 696041

ResearcherID: L-5417-2016

Scopus Author ID: 55463680700

Yury A. Ragulin – Cand. Sci. (Med.), researcher of the department of radiation and surgical treatment of thoracic region diseases

4 Korolev str., Obninsk 249036

SPIN: 6453-6594

AuthorID: 696041

ResearcherID: L-5417-2016

Scopus Author ID: 55463680700

МРНЦ им. А.Ф.Цыба – филиал ФГБУ «Национальный медицинский исследовательский центр радиологии» Министерства здравоохранения Российской ФедерацииРоссияA.F.Tsyb Medical Radiological Research Center – Branch of the National Medical Research Radiological CenterRussian Federation202011092020735162Copyright © Усачев В.С., Смоленов Е.И., Рагулин Ю.А., 20202020Усачев В.С., Смоленов Е.И., Рагулин Ю.А.Usachev V.S., Smolenov E.I., Ragulin Y.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpmj.ru/rpmj/article/view/588

Рак легкого занимает одно из лидирующих мест в мире по показателю заболеваемости и смертности. Несмотря на усовершенствование диагностических процедур, все же большинство случаев данного заболевания диагностируется на распространенных и метастатических стадиях. В последние годы были зарегистрированы новые подходы к системному противоопухолевому лечению, которые являются основным методом лечения у пациентов с IIIB — IV стадией. В диагностике и стадировании рака легкого в настоящее время всё чаще используются минимально инвазивные методы забора тканей, такие как эндобронхиальное ультразвуковое исследование или эндоскопическое ультразвуковое исследование с игольчатой аспирацией, трансбронхиальная биопсия и трансторакальная КТ-контролируемая трепан-биопсия. В проведенном анализе литературы оцениваются данные методики по риску возникновения осложнений и возможности забора достаточного количества материала для морфологического исследования, необходимого для морфологического и молекулярно-генетического тестирования. Важно понимать, как небольшой объём биопсийного материала, полученного с помощью минимально инвазивных методик, обрабатывается и оценивается патоморфологами. Важным условием является получение достаточного количество клеточного или тканевого субстрата, позволяющее надежно установить злокачественность процесса, определить гистологический тип опухоли (аденокарцинома или плоскоклеточный рак), провести иммуногистохимическое, а также молекулярно-генетическое исследование для определения показаний к назначению таргетной иммунотерапии и выборе режима химиотерапии. Необходимо проведение максимально щадящей и предоставляющей достаточно большой объём ткани однократной процедуры. Метод получения материала должен подбираться индивидуально в зависимости от локализации патологического образования, состояния больного и возможностей клиники.

Lung cancer is one of the leading causes of death in the world. Despite improvements in diagnostic procedures, most cases of this disease are diagnosed at common and metastatic stages. In recent years, new approaches to systemic antitumor treatment have been registered, which are the main method of treatment in patients with stage IIIB-IV. The diagnosis and staging of patients with lung cancer in recent decades has increasingly relied on minimally invasive tissue sampling techniques, such as endobronchial ultrasound (EBUS) or endoscopic ultrasound (EUS) needle aspiration, transbronchial biopsy, and transthoracic image guided core needle biopsy. These modalities have been shown to have low complication rates, and provide adequate cellular material for pathologic diagnosis and necessary ancillary molecular testing. It is important to understand how a small amount of biopsy material obtained using minimally invasive techniques is processed and evaluated by pathologists. An important condition is obtaining a sufficient number of cell or tissue substrate, can reliably establish the malignant process, to determine the histologic tumor type (whether it’s adenocarcinoma or squamous cell carcinoma), carry out the immunohistochemical and molecular genetic study to determine indications for the purpose of targeted, immunotherapy and the selection of chemotherapy regimen. It is necessary to conduct a single procedure that is as gentle as possible and provides a sufficiently large amount of tissue. The method of obtaining the material should be selected individually depending on the location of the pathological formation, the patient's condition and the capabilities of the clinic.

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The authors declare that there are no conflicts of interest present.