Tumor Mutational Burden (TMB) is the measurement of mutations that occurs in the cancerous cells of the tumor and is a modern prognostic biomarker that your clinician (Oncologist) will take into consideration in order to select immunotherapy over other treatment options.
Cancer tumors that have a high TMB mean that they have more neoantigens and a relative increase in T lymphocytes that fight cancer in its microenvironment and in its periphery. These neoantigens can be detected by T lymphocytes, creating an anti-cancer response.
Human cells, including cancer cells, carry much of their protein content on their surface. Immune system cells regularly control these “surface-presenting” proteins (neoantigens). The higher the TMB of cancer, the more likely it is that the immune system will recognize cancer as “foreign” and attack it. But some cancers are “protected” by blocking them from being detected by immune system cells.
In conclusion, cancer with a high mutant load has a serious indication of immunotherapy (Checkpoint Inhibitors) that can lead to drastic improvement, eliminating the ability of cancer to “avoid” the cells of the immune system.
Strategic Tissue Management
At our fully verticalized Laboratory, we handle your sample in such way as to minimize unnecessary waste:
- Your sample is processed once (and not repeatedly) by experienced histologists, after being checked for its adequacy from the Pathologist.
- Material is obtained successively in such a way as to ensure diagnosis, immunohistochemistry & molecular tests.
- Enrichment is performed to ensure as many cells as possible, which could affect the validity of the results, a work that is performed by pathologists.
- The molecular biologist immediately processes the sample in a fully controlled environment, using next-generation sequencing (NGS), or polymerase chain reaction of real-time (Real-time PCR) for the detection of mutations in genes of interest, or by the method of immunohistochemistry (IHC) on a certified platform to control tumor protein expression.
The pathologist is responsible for enriching the tumor cells in a target tissue sample. To increase the sensitivity of the detection of a mutation, we use methods to enrich the sample test with techniques that require the user to be familiar with microscopy and histopathology.
Your sample is often not just a paraffin cube, but multiple paraffin cubes. In microDiagnostics Ltd we support that you send us more than one paraffin cube and this is because only in this way we can ensure that the most appropriate sample of your tumor will be analyzed, giving you reliable and quality results.
The pathologist is responsible for selecting and evaluating the paraffin blocks of the tumor. He or she determines whether there are a sufficient amount and quality of the tumor to be used for DNA extraction. In addition, before evaluating, he evaluates the microenvironment of the tumor and its relation with the nearby healthy tissue in its region.
This critical procedure is performed once, in direct collaboration with the histotechnologist, who is the specialist in obtaining sections from the paraffin blocks of your sample.
Frequently Asked Questions (FAQ)
The clinical significance of this biomarker is that if it shows that cancer carries a high number of mutations, it means that there are a higher number of abnormal proteins in cancer, making it easier for cancer to be perceived as “foreign” tissue by its defense organism and more easily distinguished from healthy tissue.
Cancer with a high mutational load is a serious indication of immunotherapy (Checkpoint Inhibitors) that can lead to drastic improvement, eliminating the ability of cancer to “avoid” the cells of the immune system.
TMB is performed on the surgical specimen or in the biopsy material (paraffin blocks) on which your histological examination was performed.
In our fully verticalized Laboratory, the pathologist selects the most suitable paraffin block from the many that have been created (macro & microdissection).
We will take care of the ease and quick receipt of your sample. Please contact us at 2310 23 22 72, so that we can serve you immediately.
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One of the primary concerns of microDiagnostics’ Ltd is the protection of your personal data as well as the strict adherence to the conditions protecting your genetic material and medical results.
In full compliance with the General Data Protection Regulation (GDPR) we ensure that you are aware and conscious for any examination will be conducted and we do not announce results via phone calls.