Selection of modality for diagnosis and staging of patients with suspected non-small cell lung cancer
- Karl W Thomas, MD
Karl W Thomas, MD
- Professor of Medicine - Pulmonary, Critical Care, Allergy and Immunology
- Wake Forest School of Medicine
- Michael K Gould, MD, MS
Michael K Gould, MD, MS
- Senior Research Scientist
- Director for Health Services Research
- Department of Research and Evaluation
- Kaiser Permanente Southern California
Non-small cell lung cancer (NSCLC) accounts for approximately 85 percent of all lung cancers . The two most common histopathologic subtypes are adenocarcinoma followed by squamous carcinoma. Tissue biopsy is necessary for the diagnosis of NSCLC. It is especially important that enough tumor tissue is obtained to allow for accurate histopathologic and molecular assessment so that appropriate therapies can be administered in a timely fashion. (See "Personalized, genotype-directed therapy for advanced non-small cell lung cancer".)
This topic will discuss the general approach to selecting a modality to obtain tissue from a target biopsy site (primary tumor, lymph node, distant metastasis) for the histopathologic diagnosis and staging of NSCLC. The approach to patients with a solitary pulmonary nodule, overview of the initial evaluation and imaging of NSCLC, procedures used for tissue biopsy of NSCLC, and the 7th edition of the Tumor Node Metastasis staging system for NSCLC are discussed in detail separately. (See "Diagnostic evaluation and management of the solitary pulmonary nodule" and "Overview of the risk factors, pathology, and clinical manifestations of lung cancer" and "Overview of the initial evaluation, treatment and prognosis of lung cancer" and "Overview of the initial evaluation, diagnosis, and staging of patients with suspected lung cancer" and "Procedures for tissue biopsy in patients with suspected non-small cell lung cancer" and "Tumor node metastasis (TNM) staging system for non-small cell lung cancer".)
Histopathology is essential for the diagnosis of all types of lung cancer. A tissue biopsy is required to achieve the following goals:
●Determine whether the primary lesion is malignant or benign
●Distinguish primary lung cancer from a metastasis of a non-pulmonary primary site
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- BIOPSY INDICATIONS
- BIOPSY GOALS
- Efficient diagnosis and procedures
- Adequate biopsy size
- ASSESSING PATIENT RISK
- APPROACH TO THE PATIENT
- Assessing radiologic stage
- Our approach
- - Suspected stage IA
- - Suspected stage IB, II, or III disease
- Modality choice
- - EBUS/EUS needle aspiration
- - Alternative modalities
- - Suspected stage IV or supraclavicular node disease
- INDIVIDUALIZING THE APPROACH
- Role of multidisciplinary teams
- TNM STAGING
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS