Морфологическая и молекулярно-генетическая диагностика рака легкого: методики и проблемы

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.

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