Abstract:
Accurate diagnosis is the most important first step for the management of sarcomas. While traditional histopathology is still the mainstay in accurate diagnosis, next generation sequencing (NGS) is used increasingly both to aide in diagnosis and to identify therapeutic targets. Because NGS is somewhat expensive and time-consuming, it is not practical to sequence all sarcomas in routine practice. Therefore, pathologists and oncologists have to decide whether to sequence tumors on a case-by-case basis. Here, I will discuss our institutional approach to sequencing sarcomas, including an algorithmic framework to help guide decision-making. I will discuss “next-generation immunohistochemistry”, immunohistochemical surrogates of genetic events that can obviate the need for NGS. Lastly, I will discuss when NGS is necessary to identify therapeutic targets or even to establish a diagnosis.
