Molecular profiling of adenocarcinoma of the lung

The management of non-small cell lung cancer (NSCLC) has evolved in recent years and now requires immunohistochemistry and morphologic differentiation of pathology when distinguishing between adenocarcinoma and squamous cell carcinoma of the lung. As novel therapeutics for specific genetic alteration and rearrangement profiles in patients with adenocarcinoma are becoming increasingly available, provider awareness, tissue acquisition and specimen processing become even more vital. The gold standards of tissue acquisition have been invasive surgical procedures such as mediastinoscopy and/or video assisted thoracoscopy. However, 80% of patients with NSCLC are ultimately not surgical candidates. More recently, endobronchial ultrasound guided transbronchial needle aspiration has been shown to be a safe and potentially superior modality to obtain tissue for diagnosis, staging and molecular profiling. The preparation of acquired tissue specimens has also been the subject of study as different methods have shown improvements in cellular yield. This is of particular importance as the number of therapeutically targetable mutations and chromosomal rearrangements continues to grow the need for increasing amounts tissue will continue to drive what modality is employed in their acquisition.