Academia M. 132

Biopsia Líquida en Patología Tumoral

A Academia Nacional de Medicina de Colombia

Biopsia Líquida

La identificación de células tumorales circulantes se convirtió en un objetivo importante del estudio de la biología de las metástasis, luego ocurriría lo mismo con fragmentos circulantes de las células neoplásicas denominados exosomas, resultantes de procesos de apoptosis, para los cuales se postuló un papel importante en el preacondicionamiento de los nichos metastásicos.

Luego hubo un enfoque específico sobre fracciones de ácidos nucleicos libres como DNA y diferentes tipos de RNAs de células tumorales en la circulación (Figura 5); en su sentido más amplio, el concepto de biopsia líquida, término acuñado en 2010 (138), aunque, el concepto empezara a usarse algunos años antes (139), abarca el estudio además de la sangre de otros líquidos corporales como pleural, peritoneal, cefalorraquídeo, orina etc.

El estudio de estos elementos aporta información adicional sobre la heterogeneidad tumoral, por presentar frecuentemente características moleculares diferentes de los tumores primarios e incluso de las metástasis (138- 140).

El limitado número de estos elementos circulantes planteó un importante reto para su estudio, que llevó inicialmente al desarrollo de metodologías para su aislamiento diferencial de elementos circulantes similares provenientes de elementos celulares no neoplásicos, que se basa en el uso de métodos inmunocitoquímicos para aislar los mediante anticuerpos dirigidos contra antígenos de células epiteliales (141, 142).

(Lea También: Cáncer de Seno)

La evaluación de pacientes con recidivas recurrentes de neoplasias

La evaluación de pacientes con recidivas recurrentes de neoplasias que habitualmente requieren de la obtención de varias biopsias para su demostración y la necesidad de estudiar factores asociados a resistencia al tratamiento, encontraría en el estudio de estos elementos circulantes una alternativa, que dio lugar al desarrollo de la biopsia líquida, técnica que se basa en su evaluación mediante pruebas de PCR y secuenciación profunda (143-147).

Esta metodología además de sus ventajas por no ser invasiva, permite efectuar seguimiento a largo plazo de los pacientes, evaluando información genómica, transcriptómica y epigenetica relacionada con la heterogeneidad tumoral, para brindar a las pacientes alternativas terapéuticas cuando se detecten nuevas alteraciones moleculares que provean a los tumores de ventajas proliferativas, de escape de la respuesta inmune o asociadas a resistencia los tratamientos (141, 142, 148).

En la actualidad la biopsia líquida ya se utiliza rutinariamente en el estudio de pacientes con tumores metastásicos de seno (149, 150), pulmón (151, 152), colon (153, 154), páncreas (155), melanomas (156) entre otros y sus indicaciones ya han empezado a ser reguladas (157).

En el futuro, incluso se plantea la posibilidad de que la biopsia líquida haga parte del abordaje diagnóstico inicial de pacientes con cáncer junto con las biopsias de tejidos, e inclusive reemplazándolas en algunas situaciones como tumores de difícil acceso (142, 158, 159).

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Recibido: Noviembre 13, 2020
Aceptado: Diciembre 15, 2020

Correspondencia:
María del Pilar
Archila-Gomez archilapilar@yahoo.com

Academia Nacional de Medicina de Colombia

Revista científica arbitrada de la Academia Nacional de Medicina de Colombia. Fundada como Revista Médica en 1873. La Academia Nacional de Medicina es una institución científica de duración indefinida, sin ánimo de lucro, de derecho privado, con Personería Jurídica otorgada por el Ministerio de Justicia mediante Resolución 1241 del 29 de abril de 1958, cuya misión es contribuir al estudio y progreso de la medicina, de la educación médica y la investigación.

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