無驅動基因突變NSCLC的常規臨床治療流程包含針對程序性細胞死亡蛋白1(programmed cell death protein 1, PD-1)或其配體(programmed cell death ligand 1, PD-L1)的免疫檢查點抑制劑，病人需先進行 PD-L1蛋白測試。³⁷

PD-L1蛋白測試

一般的「PD-L1蛋白測試」以活組織檢查來測試腫瘤樣本的PD-L1蛋白表達水平^38,39。

37. UpToDate. Management of advanced non-small cell lung cancer lacking a driver mutation: Immunotherapy. Available at: http://www.uptodate.com/contents/management-of-advanced-non-small-cell-lung-cancer-lacking-a-driver-mutation-immunotherapy. Accessed: 22 Mar 2021.

38. National Center for Biotechnology Information. PD-L1 Testing in Non-small Cell Lung Cancer: Past, Present, and Future. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6639705/. Accessed at: 22 Mar 2021.

39. Medline Plus. PDL1 (Immunotherapy) Tests. Available at: https://medlineplus.gov/lab-tests/pdl1-immunotherapy-tests/. Accessed at: 30 Apr 2021.

 

胸部 X 光檢查是從胸部前方照一張X光片，通常是第一階段瞭解肺部狀況。如果 X 光顯示異常狀況，可安排進行更多的檢查²⁴。

24. American Cancer Society. Test for Lung Cancer. Available at: https://www.cancer.org/cancer/lung-cancer/detection-diagnosis-staging/how-diagnosed.html. Accessed: 22 Mar 2021.

由肺部咳出痰液，然後放在顯微鏡下觀察是否有任何癌細胞。這種方法較常用於檢查肺内氣管中生長的腫瘤²⁵。
 
在臨床診斷環境中，痰細胞學檢查的敏感性約為60％，這還取決於所檢查的痰標本數量²⁸。

25. American Cancer Society. Tests for Non-Small Cell Lung Cancer. Available at: https://www.cancer.org/cancer/non-small-cell-lung-cancer/detection-diagnosis-staging/how-diagnosed.html. Accessed 22 Mar 2021.

28. British Journal of Cancer.  Molecular sputum analysis for the diagnosis of lung cancer. Available at: https://www.nature.com/articles/bjc2013393. Accessed 22 Mar 2021.

 

CT 可以偵測到極微小的腫瘤，並顯示腫瘤的大小，形狀和位置，也可以判斷腫瘤是否已擴散至肺部附近的淋巴結²⁵。

醫生會因應情況為病人注射靜脈或口服造影劑來增強診斷的準確性。如需要靜脈注射造影劑，病人需簽署同意書²⁶。

靜脈或口服造影劑可能導致以下副作用，例如²⁷：
        -   皮膚過敏反應
        -   氣促
        -   嘔心

25. American Cancer Society. Tests for Non-Small Cell Lung Cancer. Available at: https://www.cancer.org/cancer/non-small-cell-lung-cancer/detection-diagnosis-staging/how-diagnosed.html. Accessed 22 Mar 2021.

26. Hong Kong Government. Scan Angiography Computer Scan. Available at: https://www.cancer.gov.hk/tc/cancer_diagnosis/scan_angiography/computer_scan.html. Accessed 22 Mar 2021.

27. American Cancer Society. CT Scan for Cancer. Available at: https://www.cancer.org/treatment/understanding-your-diagnosis/tests/ct-scan-for-cancer.html. Accessed 28 April 2021.

 

MRI 利用無線電波和強力磁場來提供詳細的軟組織影像，最常用來檢查肺癌是否有擴散至腦部或脊髓²⁵。

25. American Cancer Society. Tests for Non-Small Cell Lung Cancer. Available at: https://www.cancer.org/cancer/non-small-cell-lung-cancer/detection-diagnosis-staging/how-diagnosed.html. Accessed 22 Mar 2021.

 

正電子造影掃描可以檢查肺癌是否有擴散至身體其他部位，而且量化體內代謝過程的成像掃描。^29,30

進行檢查時需要在血管中注射一種輻射糖劑 (稱為 FDG)。由於體內的癌細胞生長迅速，它們會吸收較多的輻射糖劑。透過特別的鏡頭，就可以觀察到這種輻射活動²⁴。

24. American Cancer Society. Tests for Lung Cancer. Available at: https://www.cancer.org/cancer/lung-cancer/detection-diagnosis-staging/how-diagnosed.html. Accessed 28 April 2021.

29. Cancer Online Resource Hub. Positron Emission Tomography (PET scan). Available at: https://www.cancer.gov.hk/en/cancer_diagnosis/scan_angiography/positron_tomography.html. Accessed 28 April 2021.

30. PMC. Positron emission tomography in the management of lung cancer. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2732081/#:~:text=F%2Dfluorodeoxyglucose%20positron%20emission%20tomography,response%20assessment%20and%20detect%20recurrence.Accessed 28 April 2021.

 

活組織檢查是透過抽取小塊組織樣本，再加以化驗的檢查方法³³。活組織化驗能幫助診斷病因和測試癌症是否有基因突變的情況^22,33。

液體活檢是一種安全、快速、廉價且無創地準確篩查癌症的方法。 它只需要少量血液樣本，用於檢測和分期癌症。 它們也可能用於跟踪患者對癌症治療的反應³⁴。

22. Irish Cancer Society. Symptoms and diagnosis of lung cancer. Available at: https://www.cancer.ie/cancer-information-and-support/cancer-types/lung-cancer/symptoms-and-diagnosis-of-lung-cancer. Accessed: 22 Mar 2021.

33.Cancer Online Resource Hub. Biopsy. Available at:https://www.cancer.gov.hk/en/cancer_diagnosis/biopsy/biopsy.html. Accessed 30 April 2021.

34. CancerQuest. Biopsy. Available at: https://www.cancerquest.org/patients/detection-and-diagnosis/biopsy#liquid-biopsies. Accessed: 22 Mar 2021.

這可用來檢查肺內氣道內壁的狀況。這種方法採用內窺鏡來檢查氣管和支氣管，查看其內壁是否有異常生長，並可藉以協助抽取細胞樣本作活組織檢查³¹。

支氣管鏡檢查一般風險，包括³²：
     -   檢察時引起的不適（例如：咳嗽，因喉痛）
     -   鎮靜劑的副作用（例如：嗜睡，頭暈，血壓下降）

31. American Cancer Society. Bronchoscopy. Available at: https://www.cancer.org/treatment/understanding-your-diagnosis/tests/endoscopy/bronchoscopy.html. Accessed 28 April 2021.

32. Cancer Online Resource Hub.Common Cancers in Hong Kong- Lung Cancer Available at: https://www.cancer.gov.hk/en/hong_kong_cancer/common_cancers_in_hong_kong/lung_cancer.html. Accessed 30 April 2021

 

基因突變測試是一種非常專門的測試方法，用來檢查癌細胞基因是否有特定的變異。該方法需要取一小塊癌腫組織進行檢查，透過基因排序的方式以確定癌腫有否基因突變²⁵。
 
患者需透過不同的基因測試以確定癌腫有否基因突變，測試有助判斷非小細胞肺癌患者可採用什麽治療選擇最爲合適。

EGFR基因突變測試：

EGFR基因檢測方法，包括腫瘤組織進行測試、「液體活組織檢查」、逆轉錄聚合酶鏈式反應(RT-PCR)測試、數字聚合酶連鎖反應(dPCR)測試、次世代定序儀(NGS)測試。

ALK基因突變測試：

ALK基因突變檢測方法有螢光原位雜交測試(FISH)、免疫組織化學測試(IHC)和逆轉錄聚合酶鏈式反應(RT-PCR)³⁵。

ROS1基因突變測試：

ROS1基因檢測方法有螢光原位雜交測試 (FISH) 、逆轉錄聚合酶鏈式反應(RT-PCR)、免疫組織化學測試(IHC) 和新一代測序（NGS）。目前螢光原位雜交測試 (FISH)是ROS1最常用的檢測測試³⁶。

25. American Cancer Society. Tests for Non-Small Cell Lung Cancer. Available at: https://www.cancer.org/cancer/non-small-cell-lung-cancer/detection-diagnosis-staging/how-diagnosed.html. Accessed: 22 Mar 2021.

35. ALK POSITIVE. What is ALK-positive lung cancer? Available at: https://www.alkpositive.org/what-is-alk. Accessed: 22 Mar 2021.

36. National Center for Biotechnology Information. Testing for ROS1 in non-small cell lung cancer: a review with recommendations. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5082594/. Accessed: 22 Mar 2021.

 

無驅動基因突變NSCLC的常規臨床治療流程包含針對程序性細胞死亡蛋白1(programmed cell death protein 1, PD-1)或其配體(programmed cell death ligand 1, PD-L1)的免疫檢查點抑制劑，病人需先進行 PD-L1蛋白測試。³⁷

PD-L1蛋白測試

一般的「PD-L1蛋白測試」以活組織檢查來測試腫瘤樣本的PD-L1蛋白表達水平^38,39。

37. UpToDate. Management of advanced non-small cell lung cancer lacking a driver mutation: Immunotherapy. Available at: http://www.uptodate.com/contents/management-of-advanced-non-small-cell-lung-cancer-lacking-a-driver-mutation-immunotherapy. Accessed: 22 Mar 2021.

38. National Center for Biotechnology Information. PD-L1 Testing in Non-small Cell Lung Cancer: Past, Present, and Future. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6639705/. Accessed at: 22 Mar 2021.

39. Medline Plus. PDL1 (Immunotherapy) Tests. Available at: https://medlineplus.gov/lab-tests/pdl1-immunotherapy-tests/. Accessed at: 30 Apr 2021.

 

胸部 X 光檢查是從胸部前方照一張X光片，通常是第一階段瞭解肺部狀況。如果 X 光顯示異常狀況，可安排進行更多的檢查²⁴。

24. American Cancer Society. Test for Lung Cancer. Available at: https://www.cancer.org/cancer/lung-cancer/detection-diagnosis-staging/how-diagnosed.html. Accessed: 22 Mar 2021.

由肺部咳出痰液，然後放在顯微鏡下觀察是否有任何癌細胞。這種方法較常用於檢查肺内氣管中生長的腫瘤²⁵。
 
在臨床診斷環境中，痰細胞學檢查的敏感性約為60％，這還取決於所檢查的痰標本數量²⁸。

25. American Cancer Society. Tests for Non-Small Cell Lung Cancer. Available at: https://www.cancer.org/cancer/non-small-cell-lung-cancer/detection-diagnosis-staging/how-diagnosed.html. Accessed 22 Mar 2021.

28. British Journal of Cancer.  Molecular sputum analysis for the diagnosis of lung cancer. Available at: https://www.nature.com/articles/bjc2013393. Accessed 22 Mar 2021.

 

CT 可以偵測到極微小的腫瘤，並顯示腫瘤的大小，形狀和位置，也可以判斷腫瘤是否已擴散至肺部附近的淋巴結²⁵。

醫生會因應情況為病人注射靜脈或口服造影劑來增強診斷的準確性。如需要靜脈注射造影劑，病人需簽署同意書²⁶。

靜脈或口服造影劑可能導致以下副作用，例如²⁷：
        -   皮膚過敏反應
        -   氣促
        -   嘔心

25. American Cancer Society. Tests for Non-Small Cell Lung Cancer. Available at: https://www.cancer.org/cancer/non-small-cell-lung-cancer/detection-diagnosis-staging/how-diagnosed.html. Accessed 22 Mar 2021.

26. Hong Kong Government. Scan Angiography Computer Scan. Available at: https://www.cancer.gov.hk/tc/cancer_diagnosis/scan_angiography/computer_scan.html. Accessed 22 Mar 2021.

27. American Cancer Society. CT Scan for Cancer. Available at: https://www.cancer.org/treatment/understanding-your-diagnosis/tests/ct-scan-for-cancer.html. Accessed 28 April 2021.

 

MRI 利用無線電波和強力磁場來提供詳細的軟組織影像，最常用來檢查肺癌是否有擴散至腦部或脊髓²⁵。

25. American Cancer Society. Tests for Non-Small Cell Lung Cancer. Available at: https://www.cancer.org/cancer/non-small-cell-lung-cancer/detection-diagnosis-staging/how-diagnosed.html. Accessed 22 Mar 2021.

 

正電子造影掃描可以檢查肺癌是否有擴散至身體其他部位，而且量化體內代謝過程的成像掃描。^29,30

進行檢查時需要在血管中注射一種輻射糖劑 (稱為 FDG)。由於體內的癌細胞生長迅速，它們會吸收較多的輻射糖劑。透過特別的鏡頭，就可以觀察到這種輻射活動²⁴。

24. American Cancer Society. Tests for Lung Cancer. Available at: https://www.cancer.org/cancer/lung-cancer/detection-diagnosis-staging/how-diagnosed.html. Accessed 28 April 2021.

29. Cancer Online Resource Hub. Positron Emission Tomography (PET scan). Available at: https://www.cancer.gov.hk/en/cancer_diagnosis/scan_angiography/positron_tomography.html. Accessed 28 April 2021.

30. PMC. Positron emission tomography in the management of lung cancer. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2732081/#:~:text=F%2Dfluorodeoxyglucose%20positron%20emission%20tomography,response%20assessment%20and%20detect%20recurrence.Accessed 28 April 2021.

 

活組織檢查是透過抽取小塊組織樣本，再加以化驗的檢查方法³³。活組織化驗能幫助診斷病因和測試癌症是否有基因突變的情況^22,33。

液體活檢是一種安全、快速、廉價且無創地準確篩查癌症的方法。 它只需要少量血液樣本，用於檢測和分期癌症。 它們也可能用於跟踪患者對癌症治療的反應³⁴。

22. Irish Cancer Society. Symptoms and diagnosis of lung cancer. Available at: https://www.cancer.ie/cancer-information-and-support/cancer-types/lung-cancer/symptoms-and-diagnosis-of-lung-cancer. Accessed: 22 Mar 2021.

33.Cancer Online Resource Hub. Biopsy. Available at:https://www.cancer.gov.hk/en/cancer_diagnosis/biopsy/biopsy.html. Accessed 30 April 2021.

34. CancerQuest. Biopsy. Available at: https://www.cancerquest.org/patients/detection-and-diagnosis/biopsy#liquid-biopsies. Accessed: 22 Mar 2021.

這可用來檢查肺內氣道內壁的狀況。這種方法採用內窺鏡來檢查氣管和支氣管，查看其內壁是否有異常生長，並可藉以協助抽取細胞樣本作活組織檢查³¹。

支氣管鏡檢查一般風險，包括³²：
     -   檢察時引起的不適（例如：咳嗽，因喉痛）
     -   鎮靜劑的副作用（例如：嗜睡，頭暈，血壓下降）

31. American Cancer Society. Bronchoscopy. Available at: https://www.cancer.org/treatment/understanding-your-diagnosis/tests/endoscopy/bronchoscopy.html. Accessed 28 April 2021.

32. Cancer Online Resource Hub.Common Cancers in Hong Kong- Lung Cancer Available at: https://www.cancer.gov.hk/en/hong_kong_cancer/common_cancers_in_hong_kong/lung_cancer.html. Accessed 30 April 2021

 

基因突變測試是一種非常專門的測試方法，用來檢查癌細胞基因是否有特定的變異。該方法需要取一小塊癌腫組織進行檢查，透過基因排序的方式以確定癌腫有否基因突變²⁵。
 
患者需透過不同的基因測試以確定癌腫有否基因突變，測試有助判斷非小細胞肺癌患者可採用什麽治療選擇最爲合適。

EGFR基因突變測試：

EGFR基因檢測方法，包括腫瘤組織進行測試、「液體活組織檢查」、逆轉錄聚合酶鏈式反應(RT-PCR)測試、數字聚合酶連鎖反應(dPCR)測試、次世代定序儀(NGS)測試。

ALK基因突變測試：

ALK基因突變檢測方法有螢光原位雜交測試(FISH)、免疫組織化學測試(IHC)和逆轉錄聚合酶鏈式反應(RT-PCR)³⁵。

ROS1基因突變測試：

ROS1基因檢測方法有螢光原位雜交測試 (FISH) 、逆轉錄聚合酶鏈式反應(RT-PCR)、免疫組織化學測試(IHC) 和新一代測序（NGS）。目前螢光原位雜交測試 (FISH)是ROS1最常用的檢測測試³⁶。

25. American Cancer Society. Tests for Non-Small Cell Lung Cancer. Available at: https://www.cancer.org/cancer/non-small-cell-lung-cancer/detection-diagnosis-staging/how-diagnosed.html. Accessed: 22 Mar 2021.

35. ALK POSITIVE. What is ALK-positive lung cancer? Available at: https://www.alkpositive.org/what-is-alk. Accessed: 22 Mar 2021.

36. National Center for Biotechnology Information. Testing for ROS1 in non-small cell lung cancer: a review with recommendations. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5082594/. Accessed: 22 Mar 2021.

 

無驅動基因突變NSCLC的常規臨床治療流程包含針對程序性細胞死亡蛋白1(programmed cell death protein 1, PD-1)或其配體(programmed cell death ligand 1, PD-L1)的免疫檢查點抑制劑，病人需先進行 PD-L1蛋白測試。³⁷

PD-L1蛋白測試

一般的「PD-L1蛋白測試」以活組織檢查來測試腫瘤樣本的PD-L1蛋白表達水平^38,39。

37. UpToDate. Management of advanced non-small cell lung cancer lacking a driver mutation: Immunotherapy. Available at: http://www.uptodate.com/contents/management-of-advanced-non-small-cell-lung-cancer-lacking-a-driver-mutation-immunotherapy. Accessed: 22 Mar 2021.

38. National Center for Biotechnology Information. PD-L1 Testing in Non-small Cell Lung Cancer: Past, Present, and Future. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6639705/. Accessed at: 22 Mar 2021.

39. Medline Plus. PDL1 (Immunotherapy) Tests. Available at: https://medlineplus.gov/lab-tests/pdl1-immunotherapy-tests/. Accessed at: 30 Apr 2021.