{"id":2802,"date":"2022-08-26T08:59:03","date_gmt":"2022-08-26T05:59:03","guid":{"rendered":"https:\/\/marmarapatoloji.com\/?p=2802"},"modified":"2026-05-07T04:01:53","modified_gmt":"2026-05-07T04:01:53","slug":"kucuk-hucreli-disi-akciger-kanserlerinde-guncel-molekuler-patoloji-testleri","status":"publish","type":"post","link":"https:\/\/marmarapatoloji.com\/en\/2022\/08\/26\/kucuk-hucreli-disi-akciger-kanserlerinde-guncel-molekuler-patoloji-testleri\/","title":{"rendered":"Non-Small Cell Lung Cancer (Molecular Pathology Tests Current"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><strong>Metastatik k\u00fc\u00e7\u00fck h\u00fccreli d\u0131\u015f\u0131 akci\u011fer kanseri (KHDAK) tedavisi, son yirmi y\u0131lda, t\u00fcm\u00f6r h\u00fccrelerinin molek\u00fcler profili ve histolojisi taraf\u0131ndan y\u00f6nlendirilen tedavi stratejilerine odaklan\u0131larak b\u00fcy\u00fck \u00f6l\u00e7\u00fcde de\u011fi\u015fmi\u015ftir. Akci\u011fer kanser h\u00fccreleri mutasyon, amplifikasyon, insersiyon, delesyon ve translokasyon gibi bir\u00e7ok kromozomal anormallikleri i\u00e7erir. <\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">T\u00fcm\u00f6r b\u00fcy\u00fcmesini te\u015fvik eden bu genlerdeki amplifikasyonlar, nokta mutasyonlar\u0131 ya da yeniden yap\u0131sal d\u00fczenlenme sonucu olu\u015fan f\u00fczyon proteinleri onkojenik sinyal yolaklar\u0131nda kontrols\u00fcz iletime yol a\u00e7maktad\u0131r. H\u00fccrenin ya\u015famas\u0131 aberran sinyal aktivasyonunun devam etmesine ba\u011fl\u0131 oldu\u011funda onkogen ba\u011f\u0131ml\u0131l\u0131\u011f\u0131 ortaya \u00e7\u0131kmaktad\u0131r. Onkogen ba\u011f\u0131ml\u0131l\u0131\u011f\u0131na yol a\u00e7an mutasyonlar s\u00fcr\u00fcc\u00fc (driver) mutasyonlard\u0131r. S\u00fcr\u00fcc\u00fc mutasyonlara\/genetik de\u011fi\u015fiklere sahip t\u00fcm\u00f6rler, olu\u015fan gen \u00fcr\u00fcnlerini hedefleyen tedavilere kar\u015f\u0131 olduk\u00e7a hassast\u0131r.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Kime, Ne zaman, Nas\u0131l?<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">G\u00fcn\u00fcm\u00fczde EGFR mutasyonu, ALK ve ROS1 rearanjman\u0131 ve PD-L1 testleri en \u00f6nemli molek\u00fcler \u00e7al\u0131\u015fmalard\u0131r.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>\u0130leri evre ve metastatik hastal\u0131k ile ba\u015fvuran t\u00fcm non\u2013 skuam\u00f6z k\u00fc\u00e7\u00fck h\u00fccreli d\u0131\u015f\u0131 akci\u011fer karsinom (KHDAK) hastalar\u0131nda tan\u0131 kesinle\u015fti\u011fi anda e\u015f zamanl\u0131 \u2013<em>EGFR<\/em> mutasyonu, <em>ALK<\/em> ve <em>ROS1<\/em> rearranjman\u0131 testleri \u2013 istenmelidir. Her bir biyolojik belirtecin e\u015f zamanl\u0131 olarak test edilmesi, molek\u00fcler testlerin etkinli\u011fini artt\u0131r\u0131r ve doku \u00f6rneklerinin korunmas\u0131n\u0131 sa\u011flar. Klinisyenin uygun g\u00f6rd\u00fc\u011f\u00fc durumlarda (az t\u00fcm\u00f6r dokusu nedeniyle adenokarsinom komponentinin d\u0131\u015flanamad\u0131\u011f\u0131, sigara i\u00e7memi\u015f &#8211; uzun s\u00fcre \u00f6nce b\u0131rakm\u0131\u015f hasta) skuam\u00f6z h\u00fccreli karsinom hastalar\u0131nda yap\u0131lmal\u0131d\u0131r.<\/li>\n<li>Daha \u00f6nce molek\u00fcler test yap\u0131lmam\u0131\u015f erken evre hastalarda da rek\u00fcrrens veya progresyon geli\u015fti\u011finde molek\u00fcler <em>EGFR<\/em>, <em>ALK<\/em>\u00a0ve <em>ROS1<\/em>\u00a0 estleri yap\u0131lmal\u0131d\u0131r (yeni biyopsi tercih edilmelidir).<\/li>\n<li>Erken evre hastal\u0131k ile ba\u015fvuran hastalarda tan\u0131 an\u0131nda molek\u00fcler testlerin yap\u0131lmas\u0131 desteklenmektedir, ancak bu konudaki nihai karar multidisipliner bir onkoloji ekibiyle birlikte her merkeze \u00f6zel olarak al\u0131nmal\u0131d\u0131r.<\/li>\n<li>Daha \u00f6nce molek\u00fcler test yap\u0131lm\u0131\u015f olan hastalarda, lokal progresyon ve metastaz geli\u015fimi durumunda t\u00fcm\u00f6rlerin molek\u00fcler geli\u015fimi (histolojik transformasyon, yeni mutasyonlar) nedeniyle, progresyonun her evresinde ve tedavi direncinde yeni \u00f6rnekler ile molek\u00fcler test yap\u0131lmas\u0131 \u00f6nerilmektedir.<\/li>\n<li>Ba\u015flang\u0131\u00e7 TK\u0130 cevab\u0131ndan sonra metastaz \u00e7\u0131km\u0131\u015fsa, metastaz da test edilebilir.<\/li>\n<li>Bariz olarak birbirinden ba\u011f\u0131ms\u0131z ve birden fazla primer akci\u011fer adenokarsinomu olan hastalarda, her t\u00fcm\u00f6r i\u00e7in test uygulanabilir ancak tek bir t\u00fcm\u00f6r i\u00e7in birden fazla farkl\u0131 alan\u0131n test edilmesi gerekli de\u011fildir.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Refleks test :<\/strong><\/em>\u00a0\u0130deal olan\u0131, test edilmesi gereken hastalarda, tan\u0131 belirlendi\u011fi anda patolojinin testleri istem olmadan yapabilmesidir. Bu nedenle m\u00fcmk\u00fcnse istem taleplerinde evre ve hasta \u00f6zelliklerinin belirtilmesi tavsiye edilir. Bu yakla\u015f\u0131m testlerin daha k\u0131sa s\u00fcrede sonu\u00e7lanmas\u0131 sa\u011flamaktad\u0131r. Hastalar\u0131n do\u011fru zamanda do\u011fru ki\u015fiselle\u015ftirilmi\u015f tedaviyi almas\u0131n\u0131 sa\u011flamada \u00f6nemli bir rol oynar.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Ismarlama test :<\/strong><\/em>\u00a0Molek\u00fcler testlerin gerek oldu\u011fu zaman istek \u00fczerine yap\u0131lmas\u0131d\u0131r. Bu testlerin ileri bir zamanda yap\u0131lmas\u0131 gerekebilece\u011finden doku saklanmas\u0131 gerekmektedir. Bu testler gerekti\u011finde yap\u0131laca\u011f\u0131ndan zaman ve para kayb\u0131 olmayacakt\u0131r. Ancak istekte bulunduktan sonra sonu\u00e7lanmas\u0131 zaman almaktad\u0131r.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Total sonu\u00e7lanma ve raporlama s\u00fcresi:<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">T\u00fcm testler i\u00e7in raporlama s\u00fcresi<strong> 10 i\u015f g\u00fcn\u00fc<\/strong> (<em>2 hafta<\/em>) olarak \u00f6nerilmektedir.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Akci\u011fer Kanserinde Multidisipliner Yakla\u015f\u0131m\u0131n \u00d6nemi<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Klinisyen ve patolog aras\u0131ndaki iyi ileti\u015fim ile:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>\u0130\u015flemi ger\u00e7ekle\u015ftiren doktorun, molek\u00fcler \u00e7al\u0131\u015fma i\u00e7in kazan\u0131lm\u0131\u015f diren\u00e7 ku\u015fkusunda, \u00f6zellikle b\u00fcy\u00fcyen lezyonlardan biyopsi al\u0131nmas\u0131n\u0131n \u00f6nemli oldu\u011funu bilmesi,<\/li>\n<li>Molek\u00fcler \u00e7al\u0131\u015fman\u0131n \u00f6ncelikle yap\u0131lmas\u0131 gerekti\u011finde, patolo\u011fun bilgilendirilmesi,<\/li>\n<li>Formaline maruz kalma zamanlar\u0131n\u0131 s\u0131n\u0131rlamak i\u00e7in \u00f6rneklerin cuma g\u00fcn\u00fc veya tatil g\u00fcnlerinden \u00f6nceki g\u00fcn al\u0131nmamas\u0131n\u0131n sa\u011flanmas\u0131,<\/li>\n<li>Materyalin \u00f6ncelikli olarak korunmas\u0131 i\u00e7in \u00f6zel i\u015flemlerin gerekti\u011fine dair bildirimin yap\u0131lmas\u0131,<\/li>\n<li>\u0130\u015flem amac\u0131n\u0131n hangi spesifik molek\u00fcler veya yard\u0131mc\u0131 testler i\u00e7in oldu\u011funun bilinmesi sa\u011flan\u0131r.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Akci\u011fer adenokarsinomu ve adenokarsinom komponentinin d\u0131\u015flanmad\u0131\u011f\u0131 t\u00fcm\u00f6rlerde EGFR mutasyonlar\u0131, ALK ve ROS-1 bak\u0131lmas\u0131 \u00f6nerilmektedir.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Zorunlu test kategorisindeki genler i\u00e7in hedeflenen testler<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">E\u015f zamanl\u0131 olarak <em>EGFR<\/em> mutasyonu, <em>ALK<\/em> ve <em>ROS-1<\/em> rearranjmanlar\u0131na y\u00f6nelik molek\u00fcler testler<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><u>\u0130kinci kategori genler <\/u><\/strong><em>(B-raf, MET, Erb-B2 [HER2], Ret, K-ras)<\/em><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Test Yap\u0131lacak T\u00fcm\u00f6r Tipleri<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">K\u00fc\u00e7\u00fck h\u00fccreli d\u0131\u015f\u0131 karsinom:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Adenokarsinom<\/li>\n<li>Adenoskuam\u00f6z karsinom<\/li>\n<li>B\u00fcy\u00fck h\u00fccreli karsinom<\/li>\n<li>KHDAK-NOS<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Test Yap\u0131lmas\u0131 \u00d6nerilmeyen T\u00fcm\u00f6r Tipleri<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>P\u00fcr n\u00f6roendokrin karsinom<\/li>\n<li>P\u00fcr k\u00fc\u00e7\u00fck h\u00fccreli karsinom<\/li>\n<li>P\u00fcr skuam\u00f6z h\u00fccreli karsinom<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>\u2022 Y\u00fcksek klinik \u015f\u00fcphe durumunda<\/strong>:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Gen\u00e7 &lt;50 ya\u015f, hi\u00e7 sigara i\u00e7memi\u015f veya az i\u00e7mi\u015f hastalarda <em>EGFR, ALK<\/em> ve <em>ROS1<\/em> testi adenokarsinom d\u0131\u015f\u0131ndaki histolojilerdeki t\u00fcm\u00f6rlerde de uygulanabilir.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Akci\u011fer kanserinde uygulanacak molek\u00fcler testler i\u00e7in kullan\u0131lacak kesitlerin se\u00e7imi<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Molek\u00fcler testler i\u00e7in kullan\u0131lacak kesitlerin se\u00e7iminde bir patoloji uzman\u0131 yer almal\u0131d\u0131r ve se\u00e7im s\u00fcrecinde t\u00fcm\u00f6r\u00fcn yap\u0131s\u0131, sitolojisi ve \u00f6rnek kalitesi de\u011ferlendirilmelidir.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Patologlar, mevcut \u00f6rneklerin akci\u011fer kanseri biyobelirte\u00e7lerine ait molek\u00fcler testler i\u00e7in yeterli olup olmad\u0131\u011f\u0131n\u0131 belirlemek amac\u0131yla bu \u00f6rneklerin i\u00e7erdikleri kanser h\u00fccresi miktar\u0131n\u0131, doku korunma d\u00fczeyini ve n\u00fckleik asit kalite ve kantitesini de\u011ferlendirmelidir.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Her \u00f6rnek t\u00fcm\u00f6r i\u00e7eri\u011fi y\u00f6n\u00fcnden de\u011ferlendirilmeli ve gerekti\u011finde t\u00fcm\u00f6r h\u00fccrelerinin zenginle\u015ftirilmesi i\u00e7in mikrodiseksiyon\/makrodiseksiyon i\u015flemi yap\u0131lmal\u0131d\u0131r.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Raporlama s\u0131ras\u0131nda minimal t\u00fcm\u00f6r h\u00fccresi i\u00e7eren \u00f6rneklerden molek\u00fcler testlerin yap\u0131lmas\u0131 ile ilgili k\u0131s\u0131tlamalar\u0131n ve uyar\u0131lar\u0131n belirtilmesi gerekir. Pozitif sonu\u00e7lar her zaman de\u011ferli olmakla birlikte, negatif sonu\u00e7lar dikkatli bir \u015fekilde yorumlanarak gerekirse test sonucunun ge\u00e7ersiz olabilece\u011fi ak\u0131lda tutulmal\u0131d\u0131r.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Test i\u00e7in t\u00fcm\u00f6r miktar\u0131\/t\u00fcm\u00f6r h\u00fccre say\u0131s\u0131 her laboratuvar ve kullan\u0131lan y\u00f6ntem i\u00e7in teyit edilmelidir. DNA sekanslama i\u00e7in en az 20ng (300-400 h\u00fccre), FISH testi i\u00e7in 50-100 canl\u0131 h\u00fccre gereklidir.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Molek\u00fcler testler i\u00e7in yeterli t\u00fcm\u00f6r h\u00fccresi yoksa, hasta i\u00e7in zaman kayb\u0131 olu\u015fmas\u0131n\u0131 engellemek i\u00e7in, bu bilgi onkoloji ve g\u00f6\u011f\u00fcs hastal\u0131klar\u0131 uzmanlar\u0131yla derhal payla\u015f\u0131lmal\u0131d\u0131r<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">EGFR mutasyon testi raporunda yer almas\u0131 gerekenler<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Hasta bilgileri<\/li>\n<li>Test edilen materyalin \u00f6zellikleri (\u0130\u0130A, parafin blok vb.)<\/li>\n<li>Doku tipi (Lenf nodu, akci\u011fer, beyin vb.)<\/li>\n<li>Patolojik tan\u0131<\/li>\n<li>T\u00fcm\u00f6r y\u00fczdesi<\/li>\n<li>Kullan\u0131lan metod<\/li>\n<li>Testin analitik sensitivitesi<\/li>\n<li>Test edilen ekzonlar<\/li>\n<li>Mutasyon durumu<\/li>\n<li>Sonu\u00e7la ilgili yorum<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">ALK ve ROS-1 rearranjman\u0131 analiz raporu raporunda yer almas\u0131 gerekenler<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Hasta bilgileri<\/li>\n<li>Test edilen materyalin \u00f6zellikleri (\u0130\u0130A, parafin blok vb)<\/li>\n<li>Doku tipi (Lenf nodu, akci\u011fer, beyin vb.)<\/li>\n<li>Patolojik tan\u0131<\/li>\n<li>T\u00fcm\u00f6r y\u00fczdesi ve h\u00fccre say\u0131s\u0131<\/li>\n<li>Kullan\u0131lan metod:<\/li>\n<li>\u0130mm\u00fcnhistokimya: Antikor (klon) ve kullan\u0131lan platform<\/li>\n<li>FISH: Metod ve Prob<\/li>\n<li>E\u015fik de\u011fer<\/li>\n<li>Sonu\u00e7: Analiz yap\u0131lan nukleus say\u0131s\u0131 ve mutasyon durumu<\/li>\n<li>Sonu\u00e7la ilgili yorum<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Molek\u00fcler testlerin yap\u0131lmas\u0131 i\u00e7in ba\u015fka bir laboratuvara sevk edilmesi<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Molek\u00fcler testlerin yap\u0131lmas\u0131 i\u00e7in ba\u015fka bir laboratuvara sevk edildi\u011fi durumlarda az miktarda t\u00fcm\u00f6r h\u00fccresi i\u00e7eren \u00f6rnekler nedeniyle belirli zorluklarla kar\u015f\u0131la\u015f\u0131labilir. Belirli say\u0131da kesit g\u00f6nderilmesi ise istenen t\u00fcm \u00e7al\u0131\u015fmalar i\u00e7in yeterli materyalin olmamas\u0131, yanl\u0131\u015f kesit kal\u0131nl\u0131\u011f\u0131 veya test i\u00e7in gereken kesitin pozitif \u015farjl\u0131 lam \u00fczerinde olmamas\u0131 gibi g\u00fc\u00e7l\u00fcklere neden olabilir.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Laboratuvarlar, parafin bloklar\u0131 ile birlikte \u00f6nceden kesilmi\u015f slaytlar\u0131 da yollayarak, dokular\u0131n t\u00fckenmi\u015f olmas\u0131 durumunda mevcut di\u011fer materyale dayal\u0131 molek\u00fcler testlerin zaman\u0131nda tamamlanmas\u0131na olanak sa\u011flayabilir.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Tan\u0131sal ve PD-L1 (programmed death \u2013 ligand 1) imm\u00fcnhistokimyasal \u00e7al\u0131\u015fma ile\u00a0<em>ALK<\/em>\u00a0ve\u00a0<em>ROS1<\/em>\u00a0testi (\u0130HK\/FISH) i\u00e7in en az 4\u20136 adet 4 \u03bcm kesit,\u00a0<em>EGFR<\/em>\u00a0mutasyon testi i\u00e7in 2\u20133 adet 10 \u03bcm kesit gereklidir.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Daha \u00f6nce imm\u00fcnohistokimyasal boyanm\u0131\u015f kesitlerin de testlerin yap\u0131laca\u011f\u0131 laboratuvara g\u00f6nderilmesi \u00e7ok yard\u0131mc\u0131 olacakt\u0131r. Dokunun yeterli olmad\u0131\u011f\u0131 durumlarda boyal\u0131 kesitler \u00fczerindeki doku kaz\u0131narak veya soldurularak molek\u00fcler testler i\u00e7in \u00e7al\u0131\u015fma denenebilir.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Kaynak :<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.turkpath.org.tr\/Akciger_Kanseri_Kilavuz_2018\">https:\/\/www.turkpath.org.tr\/Akciger_Kanseri_Kilavuz_2018<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Metastatic non-small cell lung cancer (NSCLC) therapy, in the last two decades, by focusing on the molecular profile of tumor cells to a large extent driven by histology and treatment strategies has changed. A mutation in lung cancer cells, amplification, insertion, deletion and includes many chromosomal abnormalities such as translocation.<\/p>","protected":false},"author":1,"featured_media":2819,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11],"tags":[],"class_list":["post-2802","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>K\u00fc\u00e7\u00fck H\u00fccreli D\u0131\u015f\u0131 Akci\u011fer Kanserlerinde G\u00fcncel Molek\u00fcler Patoloji Testleri - Marmara Patoloji<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/marmarapatoloji.com\/en\/2022\/08\/26\/kucuk-hucreli-disi-akciger-kanserlerinde-guncel-molekuler-patoloji-testleri\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"K\u00fc\u00e7\u00fck H\u00fccreli D\u0131\u015f\u0131 Akci\u011fer Kanserlerinde G\u00fcncel Molek\u00fcler Patoloji Testleri - Marmara Patoloji\" \/>\n<meta property=\"og:description\" content=\"Metastatik k\u00fc\u00e7\u00fck h\u00fccreli d\u0131\u015f\u0131 akci\u011fer kanseri (KHDAK) tedavisi, son yirmi y\u0131lda, t\u00fcm\u00f6r h\u00fccrelerinin molek\u00fcler profili ve histolojisi taraf\u0131ndan y\u00f6nlendirilen tedavi stratejilerine odaklan\u0131larak b\u00fcy\u00fck \u00f6l\u00e7\u00fcde de\u011fi\u015fmi\u015ftir. 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