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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 J+Pathol+Transl+Med
2017 ; 51
(2
): 103-121
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Molecular Testing for Gastrointestinal Cancer
#MMPMID28219002
Lee HS
; Kim WH
; Kwak Y
; Koh J
; Bae JM
; Kim KM
; Chang MS
; Han HS
; Kim JM
; Kim HW
; Chang HK
; Choi YH
; Park JY
; Gu MJ
; Lhee MJ
; Kim JY
; Kim HS
; Cho MY
J Pathol Transl Med
2017[Mar]; 51
(2
): 103-121
PMID28219002
show ga
With recent advances in molecular diagnostic methods and targeted cancer
therapies, several molecular tests have been recommended for gastric cancer (GC)
and colorectal cancer (CRC). Microsatellite instability analysis of
gastrointestinal cancers is performed to screen for Lynch syndrome, predict
favorable prognosis, and screen patients for immunotherapy. The epidermal growth
factor receptor (EGFR) tyrosine kinase inhibitor has been approved in metastatic
CRCs with wildtype RAS (KRAS and NRAS exon 2-4). A BRAF mutation is required for
predicting poor prognosis. Additionally, amplification of human epidermal growth
factor receptor 2 (HER2) and MET is also associated with resistance to EGFR
inhibitor in metastatic CRC patients. The BRAF V600E mutation is found in
sporadic microsatellite unstable CRCs, and thus is helpful for ruling out Lynch
syndrome. In addition, the KRAS mutation is a prognostic biomarker and the PIK3CA
mutation is a molecular biomarker predicting response to phosphoinositide
3-kinase/AKT/mammalian target of rapamycin inhibitors and response to aspirin
therapy in CRC patients. Additionally, HER2 testing should be performed in all
recurrent or metastatic GCs. If the results of HER2 immunohistochemistry are
equivocal, HER2 silver or fluorescence in situ hybridization testing are
essential for confirmative determination of HER2 status. Epstein-Barr
virus-positive GCs have distinct characteristics, including heavy lymphoid
stroma, hypermethylation phenotype, and high expression of immune modulators.
Recent advances in next-generation sequencing technologies enable us to examine
various genetic alterations using a single test. Pathologists play a crucial role
in ensuring reliable molecular testing and they should also take an integral role
between molecular laboratories and clinicians.