How do you approach pathologic review and genomic testing, if indicated, of a spindle cell neoplasm?
For example, if a biopsy reads: lesion comprised of spindle cells arranged in a fascicular pattern, elongated, hyperchromatic nuclei, focally positive for SMA, negative for WT1, ALK 1, EMA, BCL-2, CD34, desmin. MIB-1 labeling 2 to 3%.
Do you obtain next-generation sequencing on all sarcomas outside of a clinical trial? If so, how do you utilize them for management, if at all?
1 Answer
Mednet MemberInvited Expert
Medical Oncology · Dana-Farber Cancer Institute
Answered on
Experienced sarcoma pathologists should review cases such as this. The rate of a change in diagnosis upon pathology review at a sarcoma center, after an initial review by a general pathologist, is surprisingly high (Ray-Coquard et al 2012, Annals Oncol).
Unless there is a specific diagnostic concern, I generally reserve broad genomic testing by NGS for patients with metastatic disease who are likely to progress on standard therapy. Although the likelihood of finding actionable mutations is low, ...
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