Last updated March 15, 2022

Establishing The Diagnosis Of Lung Cancer: Diagnosis And Management Of Lung Cancer

Recommendations

Diagnosis of Pleural Abnormalities

In patients suspected of having SCLC based on the radiographic and clinical findings, it is recommended that the diagnosis be confirmed by the least invasive method (sputum cytology, thoracentesis, FNA, bronchoscopy including TBNA), as dictated by the patient’s presentation. (1, C)
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In patients suspected of having lung cancer, who have extensive infiltration of the mediastinum based on radiographic studies and no evidence of extrathoracic metastatic disease (negative PET scan), it is recommended that the diagnosis of lung cancer be established by the least invasive and safest method (bronchoscopy with TBNA, EBUS-NA, EUS-NA, TTNA, or mediastinoscopy). (1, C)
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In patients suspected of having lung cancer who have a solitary extrathoracic site suspicious of a metastasis, it is recommended that tissue confirmation of the metastatic site be obtained if a FNA or biopsy of the site is feasible. (1, C)
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In patients suspected of having lung cancer, who have lesions in multiple distant sites suspected of metastases but in whom biopsy of a metastatic site would be technically difficult, it  is recommended that diagnosis of the primary lung lesion be obtained by the least invasive method. (1, C)
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In patients suspected of having lung cancer who have an accessible pleural effusion, thoracentesis is recommended to diagnose the cause of the pleural effusion. (1, C)
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In patients suspected of having lung cancer who have an accessible pleural effusion, if pleural fluid cytology is negative, pleural biopsy (via image-guided pleural biopsy, medical or surgical thoracoscopy) is recommended as the next step. (1, C)
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Diagnosis of Primary Tumor

In patients suspected of having lung cancer, if sputum cytology is done but is negative for carcinoma, it is recommended that further testing be performed. (1, C)
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In patients suspected of having lung cancer, who have a central lesion, bronchoscopy is recommended to confirm the diagnosis. However, it is recommended that further testing be performed if bronchoscopy results are non-diagnostic and suspicion of lung cancer remains. (1, B)
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In patients suspected of having lung cancer, who have a peripheral lung nodule, and a tissue diagnosis is required due to uncertainty of diagnosis or poor surgical candidacy, radial endobronchial ultrasound (EBUS) is recommended as an adjunct imaging modality. (1, C)
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In patients with peripheral lung lesions difficult to reach with conventional bronchoscopy, electromagnetic navigation guidance is recommended if the equipment and the expertise are available. (1, C)
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In patients suspected of having lung cancer who have a peripheral lesion, and who require tissue diagnosis before further management can be planned, transthoracic needle aspiration (TTNA) is diagnostic option. However, it is recommended that further testing be performed if TTNA results are non-diagnostic and suspicion of lung cancer remains. (1, B)
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In patients suspected of having lung cancer, the diagnosis of non-small cell lung cancer made on cytology (sputum, TTNA, bronchoscopic specimens, or pleural fluid) is reliable. However, it is recommended that adequate tissue be obtained to accurately define the histologic type and to perform molecular analysis when applicable.
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The possibility of an erroneous diagnosis of SCLC on a cytology specimen must be kept in mind if the clinical presentation or clinical course is not consistent with that of SCLC. In such a case, it is recommended that further testing be performed to establish a definitive cell type. (1, B)
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Recommendation Grading

Overview

Title

Establishing The Diagnosis Of Lung Cancer: Diagnosis And Management Of Lung Cancer

Authoring Organization

Publication Month/Year

May 1, 2013

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

Lung cancer is usually suspected in individuals who have an abnormal chest radiograph or have symptoms caused by either local or systemic effects of the tumor. The method of diagnosis of lung cancer depends on the type of lung cancer (small cell lung cancer or non-small cell lung cancer [NSCLC]), the size and location of the primary tumor, the presence of metastasis, and the overall clinical status of the patient. The objective of this study was to determine the test performance characteristics of various modalities for the diagnosis of suspected lung cancer.

Target Patient Population

Patients with suspected lung cancer

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Hospital, Operating and recovery room, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Diagnosis

Diseases/Conditions (MeSH)

D008175 - Lung Neoplasms, D001999 - Bronchoscopy, D001707 - Biopsy, Needle, D061765 - Endoscopic Ultrasound-Guided Fine Needle Aspiration

Keywords

lung cancer, fine needle aspiration, biopsy, bronchoscopy