Biopsy and personalized medicine.
Biopsy and personalized medicine.
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活检和个性化医疗。
DOI：
10.1038/nrgastro.2012.100-c1
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
Wood,BradfordJ
中科院分区：
文献类型：
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作者：
Amalou,Hayet;Wood,BradfordJ
个性化医疗依赖于准确的活检。 David C. Whitcomb 的《观点》文章（什么是个性化医疗以及它应该取代什么？ Nat. Rev. Gastroenterol. Hepatol. 9, 418–424 [2012]），1 提到了癌症，但我们想强调与肝脏和胃肠道恶性肿瘤相关的个性化医疗的一个重要领域。个性化药物起源于胃肠道恶性肿瘤，伊马替尼用于治疗胃肠道间质瘤。活检的作用可能会超出诊断范围，以促进更准确地确定哪些靶向治疗有效。在过去 5 年中，融合引导活检技术（图 1）的出现使得多模态活检成为可能，或者以前瞻性和准确的方式将组织参考任何图像（CT、MRI 或 PET）。 2-3 这种能力可能有助于在靶向药物选择或验证过程中对肿瘤指纹进行个性化表征，其成功可能取决于肿瘤内是否存在特定的生物标志物、受体、突变或配体。通过 3D PET 扫描或基于 MRI 的血管密度或扩散图的数据进行代谢指导来引导活检针的能力可能会对药物敏感性、代谢组学、预后或预期药物效果的验证产生影响。 4-6 序贯活检（给药前后）在药物发现和验证中也发挥着作用7, 8，并且可能在胃肠道癌和肝癌的进一步个体化方面发挥增强作用。此外，成像特征与特定遗传标记的相关性还处于起步阶段，有望增强活检在个性化医疗中的重要性，并强调成像作为组织生物学替代生物标记的作用。 9随着活检的功能不断扩展到诊断之外，以促进提高预后、代谢组学和肿瘤对药物敏感性的准确性，并促进个性化医疗的药物发现，使用提高准确性的多种成像模式的融合引导活检对于医学肿瘤学家来说至关重要，因为他们试图从成像中挖掘生物学特征。
Personalized medicine relies upon accurate biopsy. The Perspectives article by David C. Whitcomb (What is personalized medicine and what should it replace? Nat. Rev. Gastroenterol. Hepatol. 9, 418–424 [2012]), 1 mentions cancer, but we wanted to highlight an important area of personalized medicine that is relevant to hepatic and gastrointestinal malignancies. Personalized drugs found their origins in gastrointestinal malignancies with imatinib for gastrointestinal stromal tumours. The role of biopsy might expand beyond diagnosis to facilitate more accurate characterization of which targeted therapies will be effective. In the past 5 years, the emergence of fusion-guided biopsy technologies (Figure 1) has enabled multimodality biopsy, or referencing of the tissue to any image (CT, MRI or PET) in a prospective and accurate way. 2–3 This ability might facilitate personalized characterization of tumour fingerprints during targeted drug selection or validation, whose success might depend on the presence or absence of specific biomarkers, receptors, mutations or ligands within the tumour. The ability to guide a biopsy needle with metabolic guidance from data from a 3D PET scan or from MRI-based vascular density or diffusion maps might have implications for drug sensitivities, metabolomics, prognosis or validation of intended drug effects. 4–6 Sequential biopsy (before and after drug administration) has also had a role in drug discovery and validation7, 8 and could have an enhanced role in the further personalization of gastrointestinal and hepatic cancers. Furthermore, the correlation of imaging features with specific genetic markers is in its infancy, and promises to enhance the importance of biopsy in the personalization of medicine, and highlight the role of imaging as a surrogate biomarker for tissue biology. 9As the function of biopsy continues to expand beyond diagnosis to facilitate improved accuracy of prognosis, metabolomics and tumour susceptibility to drugs, and to facilitate drug discovery for personalized medicine, fusion-guided biopsy using multiple imaging modalities of improved accuracy could prove critical to medical oncologists as they seek to unearth biology from imaging.