Importancia del patólogo en los tumores de origen desconocido
|
|
- Meghan Butler
- 5 years ago
- Views:
Transcription
1 Importancia del patólogo en los tumores de origen desconocido Dr. Federico Rojo Fundación Jiménez Díaz, Madrid IMIM-Hospital del Mar, Barcelona
2 Cancer unknown primary 3-5 % of diagnosed cancers Variability depending of centers 60% adenocarcinomas Immunohistochemistry helps in 30-85% Metastases to liver (25%) and bone (25%) Prognosis depends of identification of primary site or actionable genomic alterations.
3 Morphology of carcinomas of unknown primary site Adenocarcinoma (50%) Poorly Differentiated Carcinomas (35%) Squamous Cell Carcinoma (5%) Neuroendocrine Carcinoma (5%) Undifferentiated Carcinoma (5%) Oien, KA & Dennis, JL. Ann Oncol 2012
4 Primary sites determined at autopsy in 884 patients with unknown primary cancer Pentheroudakis, G et al. Eur J Cancer 2007
5 Clinical landscape of cancer unknown primary over decades Greco, FA. JNCI 2013
6 IHC for CUP: performance and practice Cytokeratins Organo-specific markers (PSA, Thyroglobuline, GCDFP-15, Hepatocite) Non-organ-specific markers (CEA, p63, ER/PR, HMB45, Melan-A)
7 Screening IHC markers for the diagnosis of CUP Oien, KA & Dennis, JL. Ann Oncol 2012
8 CK profile of frequently occurring primary cancers (90%) (90%) Mesothelioma (70-90%) (70-90%) Squamous cell cancer Neuroendocrine cancer Massard, C. et al. Nat. Rev. Clin. Oncol. 2011
9 Cancer of unknown origin Breast cancer markers GCDFP-15 (sensitivity, 55%; highest in lobular and apocrine; independent of grade, ER status, mitotic index; also expressed in vulva, eyelid; never expressed in lung, colon, ovary) Mamoglobin Mamaglobin (sensitivity 46,6%, combined with GCDFP-15, sensitivity 69%) ER, PR GCDFP-15
10 Cancer of unknown origin GI cancer markers Villin (sensitive for colon ca; 5% lung adenoca) CDX-2 (sensitive for colon ca; occasionally positive in mucinous ovarian or bladder adenoca) Villin CK7 / CK20 CDX-2
11 TTF-1 38 kd member of the NKx-2 family of transcription factors Thyroid, respiratory epithelium and diencephalon Lung tumors (highest in neuroendocrine and bronchioloalveolar; lowest in squamous and mucinous) Occasional rectal and ovarian adenoc. Positive in thyroid and neuroendocrine tumors
12 Molecular profiling for CUP One gene Multiple genes
13 Strategy #1. Molecular alterations of tumor sites
14 Targetable single gene analysis in CUP 63 year old woman Disseminated cancer (liver and lung) with pleural effusion Pleural cytology: Positive for malignancy, consistent with adenocarcinoma, CK7 positive, CK20 and TTF-1 negatives
15 Targetable single gene analysis in CUP: EGFR mutation Control L858R
16 Targetable single gene analysis in CUP: EGFR mutation Pleural metastasis from pulmonary adenocarcinoma with EGFR mutation Treatment with EGFR TKI
17 Commercial Tests for Cancer of Unknown Origin Quest-Lab Corp CUPPrint Pathworks Gene Search Epitype CancerTYPE mirview mets Provider Arcturus Bioscience Agendia Pathworks diagnostics Veridex biotheranostics Rosetta Genomics Number of genes Cancer types > CpG Method PCR, gene expression Microarray, gene expression Microarray, gene expression PCR, gene expression Methylation array PCR, gene expression PCR, mirna expression Material FFPE FFPE Fresh frozen / FFPE Sensitivity (%) FFPE FFPE FFPE FFPE NA 87 92
18 MicroRNA based test to identify primary origin of metastasis Identifies the tissue-of-origin for 42 different types of tumors from seven combined classes (sarcoma, kidney, thyroid, neuroendocrine lung, germ cell, astrocytic or oligodendroglial, and pancreaticobiliary adenocarcinoma) which represent over 92% of all cancer types (a dataset that contains 1282 tumours) Leverages measure the expression level of 64 mirna using microarray platform Performance characteristics bsed on blinded validation set: sensitivity of 85%, specificity of 99.3%, sensitivity for single answer of 90%
19 Prospective mirna signature study to identify tissue of origin with CUP Varadhachary, GR et al. Clin Cancer Res 2011
20 Pathwork tissue of origin test Database of 2140 tumors of 58 types and subtypes, grouped into 15 classes: breast, bladder, colorectal, gastric, testicular germ cell, hepatocellular, kidney, non-small-cell lung, non-hodgkin s lymphoma, melanoma, ovarian, pancreatic, prostate, sarcoma and thyroid Microarray-based test that measures the expression of >1600 genes Pathwork reports similarity scores (SS) compared with each of the 15 tumour classes: SS > 60 agrees with 90% of reference diagnoses
21 Pathwork tissue of origin test
22 64 year old woman Bilateral ovarian tumors Courtesy by Dr Matias-Guiu
23
24 CK 7 negative; CK 20 positive
25
26 Gastroscopy negative Gastric biopsies: Adenocarcinoma with signed ring cells
27
28 Gastric carcinoma metastatic to the ovaries
29 50 year old woman. Vaginal Bleeding Endometrial Biopsy Bilateral Ovarian tumors Courtesy by Dr Matias-Guiu
30 AEI-AE3 + CA125 CK7 CA19.9 CK 20 + ER, PR Vimentin CDX-2 + Villin +
31
32 Metastatic adenocarcinoma (signed-ring features) of unknown origin involving the endometrium and the ovaries
33 CancerTYPE gene expression signature for molecular cancer classification Microarray development and validation on 92 selected genes by RT-PCR Database containing 2206 tumours of 30 main types and 54 subtypes Training in 466 frozen, 112 FFPE samples of primary and mx Validation in 481 frozen, 119 FFPE samples of primary and mx Ma, XJ et al. Arch Pathol Lab Med 2006
34 CancerTYPE gene expression signature for molecular cancer classification
35 Blinded comparation of CancerTYPE with IHC analysis in the diagnosis of primary site Weiss, LM et al. J Mol Diag 2013 IHC sensitivity: 61% IHC specificity: 99% CancerTYPE sensitivity: 72% CancerTYPE specificity: 99%
36 62 year old woman Breast Cancer, 8 years ago (phenotype not available, probably ER+) Peritoneal Carcinomatosis
37 CK7 Mamoglobin, GCFDP-15 ER, PR
38 High grade carcinoma, CK7 focally +, ER/PR-, HER2-, Mammoglobin-, GCFDP- 15-, WT-, Inhibin-, CA125-
39 Peritoneal metastasis of breast cancer, TN phenotype
40 For some adenocarcinomas, origins are especially difficult to establish because their morphology, IHC and molecular signatures are suggestive but not specific, and diagnostic dilemmas about the primary site are often pairwise, including pancreatic, colonic and gastrooesophageal cancer and their separation, and ovary and lung cancer.
41 Performance of CancerTYPE by tumor: limitations in certains types Erlander MG et al. J Mol Diag 2011 Kerr, SE et al. Clin Cancer Res 2012
42 Molecular profiling for CUP: clinical impact Two questions to be addressed: 1. What difference might these molecular tests make to diagnosis and management? 2. What is the impact of molecular tests on the patient outcome?
43 Difference of molecular tests for CUP in diagnosis and management Nystrom, SJ et al. Oncotarget 2012
44 Impact of molecular tests on the patient outcome: Treatment outcomes in patients with CUP and colorectal cancer molecular profile N=42, retrospective CUP patients whose molecular profiles suggested colorectal tumour, and who then received colorectal-specific therapy, had survival times longer than historical CUP controls but similar to patients with known metastatic colorectal cancer Hainsworth, JD et al. Clin Colorectal Cancer 2011
45 Impact of molecular tests on the patient outcome: Prospective treatment outcomes in patients with CUP and specific molecular profile Hainsworth, JD et al. J Clin Oncol 2013
46 Impact of molecular tests on the patient outcome: Prospective treatment outcomes in patients with CUP and specific molecular profile Direct site-specific therapy in CUP patients, yielding a median overall survival (12.2 mo) better than survival for historical controls receiving empirical CUP therapy Hainsworth, JD et al. J Clin Oncol 2013
47 Strategy #2. Actionable genomic alteration rather than site of origin for personalized therapy
48 Targetable single gene analysis in CUP 61 year old man Disseminated bilateral lung nodules cancer EBUS cytology: Positive for malignancy, consistent with adenocarcinoma, CK7, CK20 and TTF-1 negatives, EGFR WT, ALK WT
49 Targetable single gene analysis in CUP: HER2 mutation T C G T C A HER2 V842I
50 Pleural metastasis from probably GI adenocarcinoma with HER2 mutation Recruited in phase 2 clinical trial of Neratinib in Patients With Solid Tumors With Somatic Human Epidermal Growth Factor Receptor (EGFR, HER2, HER3) Mutations or EGFR Gene Amplification
51 Targeted next generation sequencing of adenocarcinoma of unknown primary site reveals frequent actionable genomic abnormalities and new routes to targeted therapies. J Ross, K Wang, GO Otto, PG Palmer, R Yelensky, D Lipson, J Chmielecki, SM Ali, D Morosini, VA Miller, PJ Stephens USCAP 2014, San Diego, abstract # 2163
52 236 cancer-related genes (3,769 exons) and 47 introns of 19 genes commonly rearranged. N=127 cancers of unknown origin: liver (24%) lymph nodes (23%), peritoneum (16%), pleura (6%), bone (5%), brain (4%) Next generation sequencing for Actionable Mutations
53 Genomic Alteration Categories Category A: Approved / standard alterations that predict sensitivity or resistance to approved / standard therapies Category B: Alterations that are inclusion or exclusion criteria for specific experimental therapies Category C: Alterations with limited evidence that predict sensitivity or resistance to standard or experimental therapies Category D: Alterations with prognostic or diagnostic utility Category E: Alterations with clear biological significance in cancer (i.e. driver mutations) without clear clinical implications Highly Actionable Actionable in Principle Prognostic Biologically Significant
54 KRAS TP53 EGFR STK11 LRP1B PIK3CA CTNNB1 NF1 MDM2 JAK2 DNMT3A CDKN2A ATM TSC1 CCNE1 BRAF SMARCA4 SMAD4 RUNX1 RB1 PTPRD NOTCH1 MYC MSH6 MAP2K1 MLH1 MCL1 GNAS FGFR2 CDKN2B CDK4 BRCA1 APC Percentage of Cases with Mutation 484 alterations (3.8 per tumor) 115 cases (91%) showed at least one actionable mutation The most common actionable mutations were: KRAS (52%), EGFR (21%), STK11 (11%), PIK3CA (7%), EGFR (7%), NF1 (6%), BRAF (4%) and others 69% of tumors has an actionable mutation in RTK/RAS pathway. 60% Genes with Actionable Alterations Genes with Alterations, Actionability Unknown 50% 40% 30% 20% 10% 0%
55 Conclusions Cancer of unknown primary site is common (3%) in cancer diagnoses Historic treatment of CUP has generally been with empiric chemotherapy with poor outcome Diagnostic technology has improved, particularly IHC and molecular tumor profiling, enabling a tissue-of-origin diagnosis Conventional pathology and IHC solves 85% of cases Combination of pathology, IHC and gene expression assays solves more than 95% of cases Gene expression tests should be interpreted in the appropriate pathological context Patients with CUP who received site-specific treatment directed by molecular assay seem to improve survival Next generation sequencing offers identification of actionable genomic alterations regardless the site of origin
PATOLOGIA MOLECULAR DEL CANCER DE ORIGEN DESCONOCIDO? Xavier Matias-Guiu Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRBLLEIDA.
PATOLOGIA MOLECULAR DEL CANCER DE ORIGEN DESCONOCIDO? Xavier Matias-Guiu Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRBLLEIDA. CANCER UNKNOWN PRIMARY 3-5 % of diagnosed cancers Variability
More informationHistopathological diagnosis of CUP
Histopathological diagnosis of CUP Dr Karin Oien karin.oien@glasgow.ac.uk Disclosure slide Dr Karin Oien has no financial interests in any company mentioned in this presentation. Dr Karin Oien is conducting
More informationNICHOLAS PAVLIDIS, MD, PhD, FRCP (Edin)
CANCER OF UNKNOWN PRIMARY A Complex Disease NICHOLAS PAVLIDIS, MD, PhD, FRCP (Edin) EMERITUS PROFESSOR, UNIVERSITY OF IOANNINA DEAN, MEDICAL SCHOOL, UNIVERSITY OF CYPRUS ESO / ESMO MASTERCLASS, SAN JOSE,
More informationNICHOLAS PAVLIDIS, MD, PhD, FRCP (Edin)
CANCER OF UNKNOWN PRIMARY A Complex Disease NICHOLAS PAVLIDIS, MD, PhD, FRCP (Edin) PROFESSOR OF MEDICAL ONCOLOGY Bogota, May-June 2016 WHAT IS CANCER OF UNKNOWN PRIMARY (CUP)? Is a clinical disorder where
More informationClinical Grade Genomic Profiling: The Time Has Come
Clinical Grade Genomic Profiling: The Time Has Come Gary Palmer, MD, JD, MBA, MPH Senior Vice President, Medical Affairs Foundation Medicine, Inc. Oct. 22, 2013 1 Why We Are Here A Shared Vision At Foundation
More informationCancers of unknown primary : Knowing the unknown. Prof. Ahmed Hossain Professor of Medicine SSMC
Cancers of unknown primary : Knowing the unknown Prof. Ahmed Hossain Professor of Medicine SSMC Definition Cancers of unknown primary site (CUPs) Represent a heterogeneous group of metastatic tumours,
More informationI. Diagnosis of the cancer type in CUP
Latest Research: USA I. Diagnosis of the cancer type in CUP II. Outcomes of site-specific therapy of the cancer type in CUP a. Prospective clinical trial b. Retrospective clinical trials 1 Latest Research:
More informationReporting of carcinoma of unknown primary tumour (CUP)
Reporting of carcinoma of unknown primary tumour (CUP) Prof John Schofield Kent Oncology Centre with grateful thanks to Dr Karin Oien University of Glasgow Royal College of Pathologists Cancer datasets
More informationApplications of IHC. Determination of the primary site in metastatic tumors of unknown origin
Applications of IHC Determination of the primary site in metastatic tumors of unknown origin Classification of tumors that appear 'undifferentiated' by standard light microscopy Precise classification
More informationThe clinically challenging entity of liver metastasis from tumors of unknown primary
The clinically challenging entity of liver metastasis from tumors of unknown primary Xuchen Zhang, MD, PhD Associate Professor of Pathology Department of Pathology Yale University School of Medicine Liver
More informationCorporate Medical Policy
Corporate Medical Policy Microarray-based Gene Expression Testing for Cancers of Unknown File Name: Origination: Last CAP Review: Next CAP Review: Last Review: microarray-based_gene_expression_testing_for_cancers_of_unknown_primary
More informationCutaneous metastases. Thaddeus Mully. University of California, San Francisco Professor, Departments of Pathology and Dermatology
Cutaneous metastases Thaddeus Mully University of California, San Francisco Professor, Departments of Pathology and Dermatology DISCLOSURE OF RELATIONSHIPS WITH INDUSTRY Thaddeus Mully Course C005 Essential
More informationTargeted Agent and Profiling Utilization Registry (TAPUR ) Study. February 2018
Targeted Agent and Profiling Utilization Registry (TAPUR ) Study February 2018 Precision Medicine Therapies designed to target the molecular alteration that aids cancer development 30 TARGET gene alterations
More informationCUP: Treatment by molecular profiling
CUP: Treatment by molecular profiling George Pentheroudakis Professor of Oncology Medical School, University of Ioannina Greece Chair, ESMO Guidelines September 2018 Enterprise Interest No disclosures.
More informationMEDICAL POLICY Gene Expression Profiling for Cancers of Unknown Primary Site
POLICY: PG0364 ORIGINAL EFFECTIVE: 04/22/16 LAST REVIEW: 07/26/18 MEDICAL POLICY Gene Expression Profiling for Cancers of Unknown Primary Site GUIDELINES This policy does not certify benefits or authorization
More informationAdnexal primary or Melanocy+c prolifera+ons in sundamaged metastatic carcinoma?
Adnexal primary or Melanocy+c prolifera+ons in sundamaged metastatic carcinoma? skin Jane L. Messina, MD Interna0onal Melanoma Pathology Working Group 4 th annual mee0ng Tampa, Florida November 14, 2011
More informationDifferential diagnosis of HCC
Hepatocellular Carcinoma Quest for an Ideal Immunohistochemical Panel Sanjay Kakar, MD UCSF Differential diagnosis of HCC Hepatocellular lesions Adenoma, FNH, HG dysplasia Adenocarcinoma CholangioCA, metastasis
More informationNext Generation Sequencing in Clinical Practice: Impact on Therapeutic Decision Making
Next Generation Sequencing in Clinical Practice: Impact on Therapeutic Decision Making November 20, 2014 Capturing Value in Next Generation Sequencing Symposium Douglas Johnson MD, MSCI Vanderbilt-Ingram
More informationCytology and the Investigation of Carcinoma of Unknown Primary (CUP) Dr Anna Green ST5, St Thomas Hospital London, UK
Cytology and the Investigation of Carcinoma of Unknown Primary (CUP) Dr Anna Green ST5, St Thomas Hospital London, UK Objectives Introduction to CUP Our experience of cytology and CUP Role of Cytology
More informationProtocol. Microarray-Based Gene Expression Testing for Cancers of Unknown Primary
Microarray-Based Gene Expression Testing for Cancers of Unknown (20454) Medical Benefit Effective Date: 04/01/14 Next Review Date: 01/15 Preauthorization No Review Dates: 05/09, 03/10, 01/11, 01/12, 01/13,
More informationCancer of Unknown Primary Site: Evolving Understanding and Management of Patients
Cancer of Unknown Primary Site: Evolving Understanding and Management of Patients F. Anthony Greco, MD Dr. Greco is the Director of the Sarah Cannon Cancer Center in Nashville, Tennessee and a member of
More informationCarcinoma of Unknown Primary (CUP)
Metasta c Carcinoma of Unknown Primary: Diagnos c Approach Using Immunohistochemistry James R. Conner, MD, PhD Mount Sinai Hospital Toronto, ON Carcinoma of Unknown Primary (CUP) 3-5% of all new malignant
More informationThe role of immunohistochemistry in surgical pathology of the uterine corpus and cervix
The role of immunohistochemistry in surgical pathology of the uterine corpus and cervix Prof. Ben Davidson, MD PhD Department of Pathology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
More informationMolecular Profiling Diagnosis in Unknown Primary Cancer: Accuracy and Ability to Complement Standard Pathology
DOI:10.1093/jnci/djt099 Article JNCI Journal of the National Cancer Institute Advance Access published May 2, 2013 The Author 2013. Published by Oxford University Press. All rights reserved. For Permissions,
More informationDisclosures Genomic testing in lung cancer
Disclosures Genomic testing in lung cancer No disclosures Objectives Understand how FISH and NGS provide complementary data for the evaluation of lung cancer Recognize the challenges of performing testing
More informationDifficult Diagnoses and Controversial Entities in Neoplastic Lung
Difficult Diagnoses and Controversial Entities in Neoplastic Lung Lynette M. Sholl, M.D. Associate Pathologist, Brigham and Women s Hospital Chief, Pulmonary Pathology Service Associate Professor, Harvard
More informationEBUS-TBNA Diagnosis and Staging of Lung Cancer
EBUS-TBNA Diagnosis and Staging of Lung Cancer Nirag Jhala MD, MIAC Professor of Pathology and Lab Med. Director of Anatomic Pathology and Cytopathology Lewis Katz School of Medicine@ Temple University
More informationLUNG CANCER. pathology & molecular biology. Izidor Kern University Clinic Golnik, Slovenia
LUNG CANCER pathology & molecular biology Izidor Kern University Clinic Golnik, Slovenia 1 Pathology and epidemiology Small biopsy & cytology SCLC 14% NSCC NOS 4% 70% 60% 50% 63% 62% 61% 62% 59% 54% 51%
More informationWhat I Learned from 3 Cases and 3 Antibodies
What I Learned from 3 Cases and 3 Antibodies Melinda Sanders, M.D Vanderbilt University Medical Center Professor of Pathology Consultant in Breast Pathology Disclosure of Relevant Financial Relationships
More informationMolecular Pathobiology of Lung Cancer. William K. Funkhouser, MD PhD Department of Pathology and Lab Medicine University of North Carolina
Molecular Pathobiology of Lung Cancer William K. Funkhouser, MD PhD Department of Pathology and Lab Medicine University of North Carolina Outline Lung Anatomy Lung Carcinoma Classification & Morphology
More informationHow to Recognize Gynecologic Cancer Cells from Pelvic Washing and Ascetic Specimens
How to Recognize Gynecologic Cancer Cells from Pelvic Washing and Ascetic Specimens Wenxin Zheng, M.D. Professor of Pathology and Gynecology University of Arizona zhengw@email.arizona.edu http://www.zheng.gynpath.medicine.arizona.edu/index.html
More informationTumor Markers Yesterday, Today & Tomorrow. Steven E. Zimmerman M.D. Vice President & Chief Medical Director
Tumor Markers Yesterday, Today & Tomorrow Steven E. Zimmerman M.D. Vice President & Chief Medical Director Tumor Marker - Definition Substances produced by cancer cells or other cells in response to cancer
More informationAnatomic Molecular Pathology: An Emerging Field
Anatomic Molecular Pathology: An Emerging Field Antonia R. Sepulveda M.D., Ph.D. University of Pennsylvania asepu@mail.med.upenn.edu 2008 ASIP Annual Meeting Anatomic pathology (U.S.) is a medical specialty
More informationCASO 1. Xavier Matias-Guiu Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRBLLEIDA.
CASO 1 Xavier Matias-Guiu Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRBLLEIDA. ASSESSMENT OF PRIMARY ORIGIN IN PATIENTS WITH A PREVIOUS HISTORY OF CANCER Primary Tumor T1 T5 T6 T13
More informationPersonalised Healthcare (PHC) with Foundation Medicine (FMI) Fatma Elçin KINIKLI, FMI Turkey, Science Leader
Personalised Healthcare (PHC) with Foundation Medicine (FMI) Fatma Elçin KINIKLI, FMI Turkey, Science Leader Agenda PHC Approach Provides Better Patient Outcome FMI offers Comprehensive Genomic Profiling,
More informationEl contexto molecular de la sobreexpresión de PD-L1 Esther Conde Gallego, MD, PhD
El contexto molecular de la sobreexpresión de PD-L1 Esther Conde Gallego, MD, PhD Laboratorio de Dianas Terapéuticas Hospital Universitario HM Sanchinarro Madrid, Spain Contents Background PD-L1 expression
More informationHow has Molecular Diagnostics changed my practice? Pulmonary Pathology
How has Molecular Diagnostics changed my practice? Pulmonary Pathology Lynette M. Sholl, M.D. Associate Pathologist Brigham and Women s Hospital Associate Director, Center for Advanced Molecular Diagnostics
More informationImmunohistochemical classification of lung carcinomas and mesotheliomas. Prof. Mogens Vyberg NordiQC Institute of Pathology Aalborg, Denmark
Immunohistochemical classification of lung carcinomas and mesotheliomas Prof. Mogens Vyberg NordiQC Institute of Pathology Aalborg, Denmark Endobronchial ultrasound guided transbronchial needle biopsy
More informationMedical Policy. MP Gene Expression Based Assays for Cancers of Unknown Primary
Medical Policy MP 2.04.54 BCBSA Ref. Policy: 2.04.54 Last Review: 03/29/2018 Effective Date: 03/29/2018 Section: Medicine Related Policies 9.01.502 Experimental / Investigational Services DISCLAIMER Our
More informationPlasma-Seq conducted with blood from male individuals without cancer.
Supplementary Figures Supplementary Figure 1 Plasma-Seq conducted with blood from male individuals without cancer. Copy number patterns established from plasma samples of male individuals without cancer
More informationGene Expression Based Assays for Cancers of Unknown Primary
2.04.54 Gene Expression Based Assays for Cancers of Unknown Primary Section Subsection Issue 06:2016 Original Policy Date December 2008 Last Review Status/Date July 2016 Next Review Status/Date July 2017
More informationList of Available TMAs in the PRN
TMA RPCI_BrainCa01 RPCI_BrCa03 RPCI_BrCa04 RPCI_BrCa05 RPCI_BrCa0 RPCI_BrCa07 RPCI_BrCa08 RPCI_BrCa15 RPCI_BrCa1 RPCI_BrCa17 RPCI_BrCa18 RPCI_BrCa19 RPCI_BrCa20 RPCI_BrCa21 RPCI_BrCa24 RPCI_BrCa25 RPCI_BrCa2
More informationMEDICAL POLICY Genetic Testing for Breast and Ovarian Cancers
POLICY: PG0067 ORIGINAL EFFECTIVE: 07/30/02 LAST REVIEW: 01/25/18 MEDICAL POLICY Genetic Testing for Breast and Ovarian Cancers GUIDELINES This policy does not certify benefits or authorization of benefits,
More informationPerfiles de expresión génica y nuevas dianas terapéuticas en cáncer de endometrio
Perfiles de expresión génica y nuevas dianas terapéuticas en cáncer de endometrio Curso Corto Actualización en Patología Ginecológica David Hardisson Departamento de Anatomía Patológica CA. DE ENDOMETRIO
More informationSection 14 Other Cancers. Cancer of Unknown 113 Primary Site INTRODUCTION PATHOLOGIC EVALUATION
Section 14 Other Cancers Cancer of Unknown 113 Primary Site F. Anthony Greco and John D. Hainsworth INTRODUCTION Cancer of unknown primary (CUP) site is a clinical syndrome that includes many types of
More informationNew Developments in Immunohistochemistry for Gynecologic Pathology
New Developments in Immunohistochemistry for Gynecologic Pathology Michael T. Deavers, M.D. Professor, Departments of Pathology and Gynecologic Oncology Immunohistochemistry in Gynecologic Pathology Majority
More informationPresentation material is for education purposes only. All rights reserved URMC Radiology Page 1 of 98
Presentation material is for education purposes only. All rights reserved. 2011 URMC Radiology Page 1 of 98 Radiology / Pathology Conference February 2011 Brooke Koltz, Cytopathology Resident Presentation
More informationGenomic Medicine: What every pathologist needs to know
Genomic Medicine: What every pathologist needs to know Stephen P. Ethier, Ph.D. Professor, Department of Pathology and Laboratory Medicine, MUSC Director, MUSC Center for Genomic Medicine Genomics and
More informationperformed to help sway the clinician in what the appropriate diagnosis is, which can substantially alter the treatment of management.
Hello, I am Maura Polansky at the University of Texas MD Anderson Cancer Center. I am a Physician Assistant in the Department of Gastrointestinal Medical Oncology and the Program Director for Physician
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Gene Expression-Based Assays Page 1 of 18 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Gene Expression-Based Assays for Cancers of Unknown Primary Professional
More informationThe Panel Approach to Diagnostics. Lauren Hopson International Product Specialist Cell Marque Corporation
The Panel Approach to Diagnostics Lauren Hopson International Product Specialist Cell Marque Corporation Cell Marque Rocklin, California About Cell Marque: IVD primary antibody manufacturer Distributors
More informationSureSelect Cancer All-In-One Custom and Catalog NGS Assays
SureSelect Cancer All-In-One Custom and Catalog NGS Assays Detect all cancer-relevant variants in a single SureSelect assay SNV Indel TL SNV Indel TL Single DNA input Single AIO assay Single data analysis
More informationGene expression profiling in patients with carcinoma of unknown primary site: from translational research to standard of care
Virchows Arch (2014) 464:393 402 DOI 10.1007/s00428-014-1545-2 REVIEW AND PERSPECTIVES Gene expression profiling in patients with carcinoma of unknown primary site: from translational research to standard
More informationThursday, March 17, pm ET
Virtual Molecular Tumor Board Host: MedStar Georgetown University Hospital Leader: Dr. John Marshall Thursday, March 17, 2016 5 pm ET Patient 1 The information contained in these slides is provided for
More informationPersonalized Medicine: Lung Biopsy and Tumor
Personalized Medicine: Lung Biopsy and Tumor Mutation Testing Elizabeth H. Moore, MD Personalized Medicine: Lung Biopsy and Tumor Mutation Testing Genomic testing has resulted in a paradigm shift in the
More informationMyriad Financial Assistance Program (MFAP)
Myriad Financial Assistance Program (MFAP) MEDICAL CRITERIA Hereditary Cancer Products The Myriad Financial Assistance Program offers aid to patients who meet specific financial and medical requirements.
More informationNew Drug development and Personalized Therapy in The Era of Molecular Medicine
New Drug development and Personalized Therapy in The Era of Molecular Medicine Ramesh K. Ramanathan MD Virginia G. Piper Cancer Center Translational Genomics Research Institute Scottsdale, AZ Clinical
More informationACCME/Disclosures. Diagnosing Mesothelioma in Limited Tissue Samples. Papanicolaou Society of Cytopathology Companion Meeting March 12 th, 2016
Diagnosing Mesothelioma in Limited Tissue Samples Papanicolaou Society of Cytopathology Companion Meeting March 12 th, 2016 Sanja Dacic, MD, PhD University of Pittsburgh ACCME/Disclosures GENERAL RULES
More information4/12/2018. MUSC Pathology Symposium Kiawah Island April 18, Jesse K. McKenney, MD
MUSC Pathology Symposium Kiawah Island April 18, 2018 Jesse K. McKenney, MD 1 Urothelial Carcinoma with Alternative Differentiation 2 Urothelial Carcinoma with Alternative Differentiation Recognition as
More informationPersonalised cancer care Information for Medical Specialists. A new way to unlock treatment options for your patients
Personalised cancer care Information for Medical Specialists A new way to unlock treatment options for your patients Contents Optimised for clinical benefit 4 Development history 4 Full FIND IT panel vs
More informationNon Small Cell Lung Cancer Histopathology ד"ר יהודית זנדבנק
Non Small Cell Lung Cancer Histopathology ד"ר יהודית זנדבנק 26.06.09 Lecture outlines WHO histological classification Macro/Micro assessment Early diagnosis Minimal pathology Main subtypes SCC, AdCa, LCLC
More informationCARCINOMA OF UNKNOWN PRIMARY: DIAGNOSTIC APPROACH USING IMMUNOHISTOCHEMISTRY
CARCINOMA OF UNKNOWN PRIMARY: DIAGNOSTIC APPROACH USING IMMUNOHISTOCHEMISTRY Jason L Hornick, MD, PhD Director of Surgical Pathology Director of Immunohistochemistry Brigham and Women s Hospital Associate
More informationGene Expression-Based Assays for Cancers of Unknown Primary Section 2.0 Medicine Subsection 2.04 Pathology/Laboratory
2.04.54 Gene Expression-Based Assays for Cancers of Unknown Primary Section 2.0 Medicine Subsection 2.04 Pathology/Laboratory Effective Date December 31, 2014 Original Policy Date June 28, 2013 Next Review
More informationGene Expression-Based Assays for Cancers of Unknown Primary
Gene Expression-Based Assays for Cancers of Unknown Primary Policy Number: 2.04.54 Last Review: 05/2018 Origination: 05/2014 Next Review: 05/2019 Policy Blue Cross and Blue Shield of Kansas City (Blue
More informationDiagnostic IHC in lung and pleura pathology
Diagnostic IHC in lung and pleura pathology Mogens Vyberg Professor of Clinical Pathology Director of NordiQC Aalborg University Hospital, Aalborg, Denmark WHO 2004 and Web Malignant mesothelioma Epithelioid
More informationHOW TO GET THE MOST INFORMATION FROM A TUMOR BIOPSY
HOW TO GET THE MOST INFORMATION FROM A TUMOR BIOPSY 7 TH Annual New York Lung Cancer Symposium Saturday, November 10, 2012 William D. Travis, M.D. Attending Thoracic Pathologist Memorial Sloan Kettering
More informationIntelliGENSM. Integrated Oncology is making next generation sequencing faster and more accessible to the oncology community.
IntelliGENSM Integrated Oncology is making next generation sequencing faster and more accessible to the oncology community. NGS TRANSFORMS GENOMIC TESTING Background Cancers may emerge as a result of somatically
More informationAscitic Fluid and Use of Immunocytochemistry. Mercè Jordà, University of Miami
Ascitic Fluid and Use of Immunocytochemistry Mercè Jordà, University of Miami Is It Malignant? Yes? No Ascitic Fluid Cytomorphologic Useful Findings Tight clusters with smooth borders Cellular and nuclear
More informationAccel-Amplicon Panels
Accel-Amplicon Panels Amplicon sequencing has emerged as a reliable, cost-effective method for ultra-deep targeted sequencing. This highly adaptable approach is especially applicable for in-depth interrogation
More informationHereditary Cancer Products
Hereditary Products Integrated BRACAnalysis (BRCA1 and BRCA2 sequencing and large rearrangement testing (BART)), covered when: PERSONAL HISTORY of Breast (must meet at least 1) Diagnosed
More informationUrinary Bladder: WHO Classification and AJCC Staging Update 2017
Urinary Bladder: WHO Classification and AJCC Staging Update 2017 Houston Society of Clinical Pathologists 58 th Annual Spring Symposium Houston, TX April 8, 2017 Jesse K. McKenney, MD Classification
More informationNext generation histopathological diagnosis for precision medicine in solid cancers
Next generation histopathological diagnosis for precision medicine in solid cancers from genomics to clinical application Aldo Scarpa ARC-NET Applied Research on Cancer Department of Pathology and Diagnostics
More informationThe Cancer Genome Atlas Pan-cancer analysis Katherine A. Hoadley
The Cancer Genome Atlas Pan-cancer analysis Katherine A. Hoadley Department of Genetics Lineberger Comprehensive Cancer Center The University of North Carolina at Chapel Hill What is TCGA? The Cancer Genome
More informationPathology Mystery and Surprise
Pathology Mystery and Surprise Tim Smith, MD Director Anatomic Pathology Medical University of South Carolina Disclosures No conflicts to declare Some problem cases Kidney tumor Scalp tumor Bladder tumor
More informationImpact of immunostaining of pulmonary and mediastinal cytology
Impact of immunostaining of pulmonary and mediastinal cytology Harman Sekhon MD, PhD Director of Cytopathology Head of Ottawa-site Ontario Tumour Bank June 20, 2014 Disclaimer Pfizer: Honorarium-Advisory
More informationAssociation of molecular status and organs with metastases at diagnosis in patients with non-small cell lung cancer (NSCLC)
Association of molecular status and organs with metastases at diagnosis in patients with non-small cell lung cancer (NSCLC) Chantal Kuijpers* 1,2, Lizza Hendriks 3, Jules Derks 3, Anne-Marie Dingemans
More informationMesothelioma: diagnostic challenges from a pathological perspective. Naseema Vorajee August 2016
Mesothelioma: diagnostic challenges from a pathological perspective Naseema Vorajee August 2016 Naseema.vorajee@nhls.ac.za Pleural diseases (whether neoplastic, reactive or infective) may have similar
More informationPrimary enteric adenocarcinoma with predominantly signet ring features of the lung: A case report with clinicopathological and molecular findings
CASE REPORT Primary enteric adenocarcinoma with predominantly signet ring features of the lung: A case report with clinicopathological and molecular findings Makoto Nagashima 1, Ayako Moriyama 1, Yasuo
More informationEvolution of Pathology
1 Traditional pathology Molecular pathology 2 Evolution of Pathology Gross Pathology Cellular Pathology Morphologic Pathology Molecular/Predictive Pathology Antonio Benivieni (1443-1502): First autopsy
More informationCarcinoma of unknown primary origin (CUP) is defined
REVIEW ARTICLE Metastatic Carcinoma of Unknown Primary: Diagnostic Approach Using Immunohistochemistry James R. Conner, MD, PhD and Jason L. Hornick, MD, PhD Abstract: Carcinoma of unknown primary origin
More informationLung Tumor Cases: Common Problems and Helpful Hints
Lung Tumor Cases: Common Problems and Helpful Hints Brandon T. Larsen, MD, PhD Senior Associate Consultant Department of Laboratory Medicine and Pathology Mayo Clinic Arizona Arizona Society of Pathologists
More informationCHAPTER 137 CANCER OF UNKNOWN PRIMARY SITE
SECTION 14: OTHER CANCERS F. ANTHONY GRECO AND JOHN D. HAINSWORTH CHAPTER 137 CANCER OF UNKNOWN PRIMARY SITE Cancer of unknown primary (CUP) site is a clinical syndrome that represents many types of cancers.
More informationpatients in the era of
Communicating with cancer patients in the era of personalized medicine September 9 th, 2017 Gerald Prager, M.D. Comprehensive Cancer Center Vienna Medical University of Vienna, Austria Gerald Prager, M.D.
More informationCase Report Testicular Signet-Ring Cell Metastasis from a Carcinoma of Unknown Primary Site: A Case Report and Literature Review
Case Reports in Oncological Medicine Volume 2016, Article ID 7010173, 5 pages http://dx.doi.org/10.1155/2016/7010173 Case Report Testicular Signet-Ring Cell Metastasis from a Carcinoma of Unknown Primary
More informationImmunohistochemistry on Fluid Specimens: Technical Considerations
Immunohistochemistry on Fluid Specimens: Technical Considerations Blake Gilks Dept of Pathology University of British Columbia, Vancouver, BC, Canada Disclosures None Learning Objectives At the end of
More informationRecent advances in breast cancers
Recent advances in breast cancers Breast cancer is a hetrogenous disease due to distinct genetic alterations. Similar morphological subtypes show variation in clinical behaviour especially in response
More informationThe Center for PERSONALIZED DIAGNOSTICS
The Center for PERSONALIZED DIAGNOSTICS Precision Diagnostics for Personalized Medicine A joint initiative between The Department of Pathology and Laboratory Medicine & The Abramson Cancer Center The (CPD)
More informationFrequency(%) KRAS G12 KRAS G13 KRAS A146 KRAS Q61 KRAS K117N PIK3CA H1047 PIK3CA E545 PIK3CA E542K PIK3CA Q546. EGFR exon19 NFS-indel EGFR L858R
Frequency(%) 1 a b ALK FS-indel ALK R1Q HRAS Q61R HRAS G13R IDH R17K IDH R14Q MET exon14 SS-indel KIT D8Y KIT L76P KIT exon11 NFS-indel SMAD4 R361 IDH1 R13 CTNNB1 S37 CTNNB1 S4 AKT1 E17K ERBB D769H ERBB
More informationFNA Cytology of Metastatic Malignancies of Unknown Primary Site
FNA Cytology of Metastatic Malignancies of Unknown Primary Site Tarik M. Elsheikh Cleveland Clinic Jan F. Silverman Alleghany Hospitals Pathologic Diagnosis of Metastasis Smaller specimens, less invasive
More informationLiquid biopsy: the experience of real life case studies
Liquid biopsy: the experience of real life case studies 10 th September 2018 Beatriz Bellosillo Servicio de Anatomía Patológica Hospital del Mar, Barcelona Agenda Introduction Experience in colorectal
More informationFluxion Biosciences and Swift Biosciences Somatic variant detection from liquid biopsy samples using targeted NGS
APPLICATION NOTE Fluxion Biosciences and Swift Biosciences OVERVIEW This application note describes a robust method for detecting somatic mutations from liquid biopsy samples by combining circulating tumor
More informationTumor Markers & Cytopathology
Tumor Markers & Cytopathology Objectives: After learning, student should be able to 1. Describe the basic concepts of tumor markers and Asst. Prof. Prasit Suwannalert, Ph.D. (Email: prasit.suw@mahidol.ac.th)
More informationBreast cancer: IHC classification. Mogens Vyberg Professor of Clinical Pathology Director of NordiQC Aalborg University Hospital, Aalborg, Denmark
Breast cancer: IHC classification Mogens Vyberg Professor of Clinical Pathology Director of NordiQC Aalborg University Hospital, Aalborg, Denmark http://upload.wikimedia.org/wikipedia/commons/1/1a/breast.svg
More informationDisclosure of Relevant Financial Relationships NON-SMALL CELL LUNG CANCER: 70% PRESENT IN ADVANCED STAGE
MORPHOLOGY AND MOLECULAR TESTING IN NON-SMALL CELL OF LUNG NEW FRONTIEIRS IN CYTOPATHOLOGY PRACTICE American Society for Cytopathology San Antonio, Texas Sunday March 5, 2017 Disclosure of Relevant Financial
More informationCytological Sub-classification of Lung Cancer: Morphologic and Molecular Characteristics. Mercè Jordà, University of Miami
Cytological Sub-classification of Lung Cancer: Morphologic and Molecular Characteristics Mercè Jordà, University of Miami Mortality Lung cancer is the most frequent cause of cancer incidence and mortality
More information3/28/2017. Disclosure of Relevant Financial Relationships. Clinical History. Pathology
Disclosure of Relevant Financial Relationships Monalisa Sur MBBS, FCPath(S.A), MMED(WITS), FRCPath(U.K), FRCP( C) Professor, Department of Pathology and Molecular Medicine Division of Anatomical Pathology
More informationHistopathology of NSCLC, IHC markers and ptnm classification
ESMO Preceptorship on Non-Small Cell Lung Cancer November 15 th & 16 th 2017 Singapore Histopathology of NSCLC, IHC markers and ptnm classification Prof Keith M Kerr Department of Pathology, Aberdeen University
More informationNEW IHC A n t i b o d i e s
NEW IHC Antibodies TABLE OF CONTENTS NEW IHC ANTIBODIES from Cell Marque CITED1 (5H6).... 1 Claudin 7 (5D10F3).... 1 GATA1 (4F5).... 1 Transgelin (2A10C2).... 1 NEW IHC ANTIBODIES using RabMAb Technology
More information7/6/2015. Cancer Related Deaths: United States. Management of NSCLC TODAY. Emerging mutations as predictive biomarkers in lung cancer: Overview
Emerging mutations as predictive biomarkers in lung cancer: Overview Kirtee Raparia, MD Assistant Professor of Pathology Cancer Related Deaths: United States Men Lung and bronchus 28% Prostate 10% Colon
More informationAssessing the lung and mediastinum in cancer-is tissue the issue? George Santis
1 Assessing the lung and mediastinum in cancer-is tissue the issue? George Santis Optimal management of Cancer Histological diagnosis & accurate staging at presentation Molecular analysis of primary tumour
More information