THE INFLUENCE OF MOLECULAR DIAGNOSTIC PRO CEDURES ON THE SURGICAL-TREATMENT OF MALIGNANT DISEASES

In the past molecular biological techniques have provided the basis fo r principally new aspects in the diagnosis of neoplastic diseases. The genetic predisposition to hereditary cancer syndromes can be detected by germ line DNA sequence analysis and offers the opportunity for pro phylactic surgery. Some preneoplastic lesions can be detected through the identification of specific molecular alterations in nucleic acid p reparations derived from various clinical samples. Residual or dissemi nated tumor cells can be detected in resection margins, lymph nodes, b one marrow, or peripheral blood with great sensitivity. Most likely, t hese techniques will strongly influence cancer screening programs and provide a rational basis for adjuvant systemic or regional therapy mod alities. However, the clinical value of these techniques has not yet b een proven in controlled trials. The problems of reproducibility and q uality assurance have to be addressed and solved. This review summariz es the basic principles of some of these new molecular diagnostic tech niques to permit a critical assessment of their clinical implications.