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– Kemajuan di bidang obat yang dipersonalisasi (terapi individual) bersama dengan teknik endoskopi

minimal invasif di bidang keganasan paru-paru telah memberikan kompleksitas dalam penanganan
sampel jaringan yang signifikan. Oleh karena adanya terapi langsung sesuai histologi, pewarnaan
(pulasan) tambahan juga sering dibutuhkan untuk mencapai keakuratan pengklasifikasian histologis
pada sampel sitologi dan biopsi kecil. Pemeriksaan reseptor EGFR, ALK dan ROS1
direkomendasikan untuk dilakukan pada pasien dengan NSCLC stadium lanjut. Sebagai tambahan,
penggunaan pemeriksaan molekuler yang maju seperti next generation sequencing juga turut
meningkat.

– Pada pasien dengan NSCLC stadium lanjut, spesimen biopsi kecil atau sitologi sering menjadi satu-
satunya sampel yang bisa diambil untuk diagnosis dan pemeriksaan biomarker. Sehingga perolehan
jaringan yang sesuai, pemrosesan dan pengelolaan berbagai uji penting untuk dicapai
dengan(melalui) kerja tim yang baik. Penanganan spesimen yang optimal penting dilakukan untuk
interpretasi preparat (sediaan) biopsi dan/atau sitologi dengan akurat dan memungkinkan
pemeriksaan molekuler dan IHC yang sukses.

– Pada kesempatan ini karakteristik spesimen, dan langkah pemrosesan akan dibahas untuk setiap
sampel paru yang umumnya diambil. Setiap kelebihan dan (keter)batasan juga akan dibahas
sehingga penanganan spesimen untuk setiap prosedur dapat memberikan keberhasilan yang tinggi
dalam mendiagnosis dengan akurat dan pada akhirnya menghasilkan perencanaan terapi yang
rasional. Penambahan informasi klinis sangat meningkatkan kemungkinan diagnosis Patologi
Anatomi yang akurat dan berarti, terutama di kondisi seperti biopsi penyakit paru difusa.

The recent advance in personalized medicine along with minimally invasive endoscopic techniques in
the field of lung cancer has brought significant complexities to handling of tissue samples. Due to the
histology-directed therapy, additional stains are frequently required to achieve accurate histologic
subtyping on small biopsy and cytology samples. It is recommended that epidermal growth factor
receptor (EGFR), anaplastic lymphoma kinase (ALK) and ROS1 testing be per- formed for patients
with advanced non-squamous small cell lung can- cer (NSCLC) in a reflex manner. In addition,
multiplex assays, including next generation sequencing (NGS), are increasingly being used for
detection of the molecular targets. Furthermore, immunohistochem- istry (IHC) for programmed death
ligand-1 (PD-L1) is now routinely performed in NSCLCs with wild type EGFR and ALK to determine
eligibility for PD-1/PD-L1 blockade.1

In most advanced NSCLC patients, a small biopsy or cytology specimen is often the only sample
available for the diagnosis and biomarker analyses. Thus, appropriate tissue acquisition, processing
and management for multiple tests are crucial and are best achieved by the interaction of all
physicians involved in the patient care.2,3 Tissue Acquisition: All the necessary work-up is usually
performed on a small biopsy or cytology specimen taken from a patient with advanced disease, tissue
sampling should be aimed at obtaining the largest yield of tumor in the safest and least invasive manner.4
Tissue Processing: Appropriate pre-analytic tissue handling is one of the keys to successful
implementation of IHC-based and molecular assays in general.3,5

Optimal specimen handling is essential for the accurate interpretation of biopsies and cytologic preparations
obtained in the course of evaluating the patient with lung disease. Sampling techniques available include
bronchoscopy, transthoracic needle core biopsy or aspiration, and surgical wedge biopsy of peripheral lung
through a transthoracic approach. In this chapter specimen characteristics and processing steps are
presented for each of the common lung samples taken in the course of clinical evaluation for
pulmonary disease. Also, for each type of sample the benefits and limitations are reviewed. Such a
working knowledge of specimen handling for each procedure ensures the greatest likelihood of success
in establishing a specific diagnosis and, in the end, a rational treatment plan. The addition of clinical
information dramatically increases the likelihood of a meaningful and accurate pathologic diagnosis,
especially in the setting of biopsies for diffuse lung disease (interstitial lung disease).