癌症相关认知损害（CRCI）常与癌症及其治疗相关，但目前的二元诊断方法未能全面捕捉该综合征的全部特征。认知功能高度复杂，存在于一个贯穿性的连续体中，而这在二元类别中很难具体描述。运用先进的统计方法对症状评估进行分析显示，CRCI存在多个亚型。然而，研究表明，仅仅依赖症状评估可能无法考虑到潜在特定认知表型所依赖的神经机制中的显著差异。将治疗计划定制于涉及个体病情的特定生理机制，是精准医学的核心所在。在这篇综述中，我们讨论了生物分型学，即在其他心理障碍中使用的精准医学框架如何应用于CRCI。具体来说，我们讨论了如何利用神经影像学来确定CRCI的生物分型，从而通过生物学机制数据提高CRCI的预测和诊断的精度。生物分型还可以为干预试验提供更精确的临床终点。利用代理影像技术或液体生物标志物可以使生物分型更加可行。需要进行大规模的横断面表型研究，并评估其纵向发展轨迹，而目前可用的数字基础设施使数据共享/池化非常可行。版权所有 © 2023 Kesler, Henneghan, Prinsloo, Palesh and Wintermark.

Cancer related cognitive impairment (CRCI) is commonly associated with cancer and its treatments, yet the present binary diagnostic approach fails to capture the full spectrum of this syndrome. Cognitive function is highly complex and exists on a continuum that is poorly characterized by dichotomous categories. Advanced statistical methodologies applied to symptom assessments have demonstrated that there are multiple subclasses of CRCI. However, studies suggest that relying on symptom assessments alone may fail to account for significant differences in the neural mechanisms that underlie a specific cognitive phenotype. Treatment plans that address the specific physiologic mechanisms involved in an individual patient's condition is the heart of precision medicine. In this narrative review, we discuss how biotyping, a precision medicine framework being utilized in other mental disorders, could be applied to CRCI. Specifically, we discuss how neuroimaging can be used to determine biotypes of CRCI, which allow for increased precision in prediction and diagnosis of CRCI via biologic mechanistic data. Biotypes may also provide more precise clinical endpoints for intervention trials. Biotyping could be made more feasible with proxy imaging technologies or liquid biomarkers. Large cross-sectional phenotyping studies are needed in addition to evaluation of longitudinal trajectories, and data sharing/pooling is highly feasible with currently available digital infrastructures.Copyright © 2023 Kesler, Henneghan, Prinsloo, Palesh and Wintermark.