Comprehensive Diagnostic Approches in Lung Carcinoma.pptx

Comprehensive Diagnostic Approaches in Lung Carcinoma

Lung carcinoma, one of the leading causes of cancer-related deaths globally, requires accurate and timely diagnosis for effective treatment. This presentation delves into the various diagnostic methods employed in the detection and characterization of lung carcinoma, encompassing both traditional and cutting-edge approaches. Topics include imaging techniques like CT and PET scans, cytopathological and histopathological analysis, molecular and genetic profiling, and emerging technologies such as liquid biopsies. By exploring the strengths and limitations of each method, this presentation aims to provide a holistic understanding of how these tools can be integrated to enhance diagnostic accuracy and patient outcomes

1. Comprehensive Diagnostic Approaches in Lung Carcinoma Dr Naila Awal Associate Professor, Dept. of Pathology 5 th February | 2025

2. Breast 2.5 Million cases (12.4%) 2.3 Million cases (11.6%) 1.9 Million cases (9.6%) 1.5 Million cases (4.9%) 970,000 cases (7.3%) Lung Colon Prostate Stomach Global Incidence of Lung Cancer "Global Cancer Observatory. (2023). World Fact Sheet. Retrieved from https://gco.iarc.who.int/media/globocan/factsheets/populations/900-world-fact-sheet.pdf

3. Demographic data According to International Agency for Research on Cancer (IARC), nearly 2.5 million individuals were diagnosed with lung cancer in 2022, and over 1.8 million died due to this disease . 2 nd most common in men (11.1% of new cases) 6 th most common in women (4.6%). "Global Cancer Observatory. (2023). Bangladesh. Retrieved from https://gco.iarc.who.int/media/globocan/factsheets/populations/50-bangladesh-fact-sheet.pdf

4. Imaging test 1 Cytopathology 2 4 Histopathology 3 5 Diagnostic approach 6 Other supportive investigations Molecular test Immunohistochemistry

5. thick-walled cavitating mass in the right lung. .CT-guided biopsy of the wall of this cavity showed squamous cell carcinoma. http://www.svuhradiology.ie/case-study/cavitating-lung-cancer/ Imaging modalities Chest X-ray Tuberculosis, Cavitary-e large cavities in both apices (white arrows) 2 irregular cavitary lesions with moderately thick walls, a necrotizing center, Bronchoalveolar lavage revealed a high amount of Aspergillus fumigatus , .

6. CT Scans: Determine size, shape, position of tumors and identify enlarged lymph nodes MRI Scans: • create detailed images of soft tissues and detect possible spread of lung cancer PET Scans: Uses radioactive sugar to highlight high metabolic activity like cancer cells. Imaging Computed tomography (CT) scan Magnetic resonance imaging (MRI) scan Positron emission tomography (PET) scan a) CT scan b) MRI- Hypointense intratumor vasculature (red) , Lymph node (yellow) & small volume pleural effusion (green arrow) Picture courtesy: https://www.sciencedirect.com/science/article/pii/S2405630820300525 PET/CT  lesions in the right lung (arrowheads), right rectus abdominis muscle (dotted arrows), multiple lymph nodes (long arrows), right ilium (short arrow).

7. Imaging techniques are essential for lung cancer evaluation but cannot confirm the exact nature of the lesion. A conclusive diagnosis requires pathological tests. The selection of test depends on the patient’s condition, tumor location, and clinical suspicion

8. More effective for central airway malignancies than peripheral or metastatic lung cancers Usually, 3 samples collected on 3 consecutive days. Sensitivity improves with the number of specimens: One specimen: 27 to 41% Three specimens: 57 to 89% Five specimens: up to 96.1% Cytopathology Sputum cytology “Non invasive test

9. Bronchial washing: Performed via bronchoscopy with 5–10 mL saline, then aspirated. Detects central airway lesions but has low diagnostic value for lung cancer overall. Limited sensitivity for small or peripheral tumors BAL Uses 100–300 mL saline. Less sensitive for lung cancer but useful for opportunistic infections specially in immunocompromised patients. Cytology Bronchial washing And Bronchoalveolar lavage (BAL)

10. Diagnostic tool used in bronchoscopy to collect samples from suspicious lesions. Used for central or visible endobronchial lesions. Contraindicated in respiratory failure and uncontrolled coughing. Cytology Bronchial brushing

11. Used for peripheral lung lesion or pleural mass lesions under imaging guidance (e.g., CT) Highly sensitive for detecting lung cancers. Cell blocks from aspirates can be used for immunohistochemistry (IHC). Cytology Transthoracic fine needle aspiration

12. Pleural effusion is a common and clinically significant complication of lung cancer. Hemorrhagic pleural effusion often a sign of malignancy which usually indicates advanced disease and associated with poorer prognosis. Cytopathology Pleural effusion

13. Provide larger tissue sample Gold standard to confirm the diagnosis Types Core biopsy: CT guided Bronchoscopic biopsy Open biopsy Lung biopsy followed by Histopathology

14. CT guided core biopsy of Lung

15. Lung Histopathology

16. A new test that examines blood samples for cancer markers. Still under research for accuracy and not yet a routine diagnostic method for lung cancer. Liquid biopsy

17. Differentiating between subtypes : i.e ; poorly differentiating adenocarcinoma (ADC) Immunohisto chemistry TTF-1 + P 40 - Poorly differentiated adenocarcinoma

18. Identifying tumor origin : Primary vs. Metastatic Tumors A 60-year-old female with a history of breast cancer treated 3 years ago presents with a new lung lesion identified on imaging. Immunohisto chemistry TTF-1 : ‘-” ER : ‘+”

19. Molecular tests identify specific genetic mutations and biomarkers in cancer cells, This helps clinicians to make a treatment plans targeting specific mutations, leading to more precise therapies. There are several molecular tests used in treatment planning- PD-L1 expression Epidermal growth factor receptor ( EGFR) gene Anaplastic lymphoma kinase (ALK) gene KRAS gene BRAF gene RET gene Molecular testing

20. T cell Cancer cell Immune response of Cancer Cells Molecular testing PD-L1 expression

21. T cell Cancer cell PD-L1 PD-1 Inactive Mechanisms of Immune Evasion by Cancer Cells Molecular testing PD-L1 expression

22. T cell Cancer cell Role of Immunotherapy in cancer cell Molecular testing PD-L1 expression

23. EGFR protein found on the surface of cells that promotes cell growth & division EGFR mutates  overly active  uncontrolled cell growth and division Molecular testing

24. Common - NSCLC, mostly in Adenocarcinoma (1/3 rd of adenocarcinoma EGFR mutation About 35% with East Asian heritage Women are more common Non smoker are more likely to have EGFR mutation

25. The good news: Targeted Therapy! Specific treatment can target EGFR mutation

26. TKI target EGFR mutation EGRF

27. D one after the diagnosis of lung cancer to assess lung function. Important for patients with poor lung function (e.g., smokers) to determine if they can withstand after removing even part of a lung. Helps surgeons to decide whether surgery is a good option, and if so, how much lung can safely be removed. Lung function tests

28. Take home message Multimodal Diagnosis is Key : No single test is sufficient—a combination of imaging, cytology, histopathology, IHC, and molecular tests ensures accuracy. Histopathology -the gold standard: Essential for identifying tumor type, grade, and differentiation, guiding precise treatment. IHC & Molecular Testing for Personalized Therapy: Biomarker testing (e.g., EGFR, PD-L1) determines eligibility for targeted therapy and immunotherapy Early & Accurate Diagnosis Improves Outcomes: Biopsy and molecular profiling improve treatment success and survival rates

29. Thank you Have a good Day