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Procedures for tissue biopsy in patients with suspected non-small cell lung cancer

Authors
Karl W Thomas, MD
Michael K Gould, MD, MS
Section Editor
James R Jett, MD
Deputy Editor
Geraldine Finlay, MD

INTRODUCTION

Lung cancer is the most common cancer worldwide. Non-small cell lung cancer (NSCLC) accounts for approximately 85 percent of all lung cancers, of which, adenocarcinoma is the most common histologic subtype [1].

Traditionally, the histopathologic diagnosis of NSCLC has been made based upon information obtained from small biopsies. There has been a shift towards the use of therapies targeted at specific mutations, the identification of which can be challenging on small biopsy samples. This, together with the rising incidence of adenocarcinoma and its classification into subgroups, has led to greater emphasis on the importance of tissue biopsy for the diagnosis of NSCLC. (See "Pathology of lung malignancies" and "Personalized, genotype-directed therapy for advanced non-small cell lung cancer".)

This topic will discuss the accuracy of procedures commonly used to obtain tissue for diagnosis and staging in patients with suspected NSCLC. The clinical presentation, initial evaluation and staging, and approach to the selection of modality for biopsy of patients with suspected NSCLC are discussed separately. (See "Overview of the initial evaluation, diagnosis, and staging of patients with suspected lung cancer" and "Selection of modality for diagnosis and staging of patients with suspected non-small cell lung cancer".)

SELECTION OF MODALITY FOR TUMOR BIOPSY

Selection of the optimal biopsy target and modality should be driven by evidence-based and institution-specific protocols that preferably involve a lung cancer tumor board or multidisciplinary team. When an institution is equipped with reliable expertise, one of the minimally invasive or more invasive tools listed in the section below may be used to biopsy a target lesion. Importantly, estimates of sensitivity and specificity for individual modalities are usually based upon small studies with inadequate gold standard comparators that lead to bias and significantly limit interpretation of the data. Furthermore, the post-test probability of malignant disease particularly in metastatic locations will depend not only on patient risk factors, but also the local prevalence of alternative diagnoses such as granulomatous disease. The clinician should be aware of these clinically relevant limitations when choosing among the modalities available for tissue acquisition. (See "Selection of modality for diagnosis and staging of patients with suspected non-small cell lung cancer" and 'Minimally invasive procedures' below and 'Surgical staging procedures' below.)

Prior to biopsy the following should be in place:

                                  

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Literature review current through: Nov 2016. | This topic last updated: Wed Nov 02 00:00:00 GMT+00:00 2016.
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