Abstract
The role of the respiratory physician in diagnosing lung cancer has increased in complexity over the last 20 years. Adenocarcinoma is now the prevailing histopathological sub-type of non-small cell lung cancer (NSCLC) resulting in more peripheral cancers. Conventional bronchoscopy is often not sufficient to obtain adequate tissue samples for diagnosis. Radiologically guided transthoracic biopsy is a sensitive alternative, but carries significant risks. These limitations have driven the development of complimentary bronchoscopic navigation techniques for peripheral tumour localisation and sampling. Furthermore, linear endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) is increasingly being chosen as the initial diagnostic procedure for those with central lesions and/or radiological evidence of node-positive disease. This technique can diagnose and stage patients in a single, minimally invasive procedure with a diagnostic yield equivalent to that of surgical mediastinoscopy. The success of molecular targeted therapies and immune checkpoint inhibitors in NSCLC has led to the increasing challenge of obtaining adequate specimens for accurate tumour subtyping through minimally invasive procedures. This review discusses the changing epidemiology and treatment landscape of lung cancer and explores the utility of current diagnostic options in obtaining a tissue diagnosis in this new era of precision medicine.
Highlights
Lung cancer remains the leading cause of cancer-related death in both men and women [1]
While non-small cell lung cancer (NSCLC) could be further classified on a resected specimen into adenocarcinoma, squamous cell carcinoma and large cell carcinoma, pursuing this sub-classification on small biopsy specimens prior to treatment was unnecessary as the histological subtype of NSCLC did not influence surgical or chemotherapeutic decisions [3]
The shift in lung cancer epidemiology from central small cell and squamous cell carcinomas to peripheral adenocarcinomas has impacted the role of traditional bronchoscopy as a first-line diagnostic tool for lung cancer
Summary
Lung cancer remains the leading cause of cancer-related death in both men and women [1]. Respiratory physicians have a pivotal role in the initial evaluation of patients with suspected lung cancer, with the key goals of obtaining an early tissue diagnosis, accurate staging and assessing the patient’s cardiorespiratory fitness. Changes in the precision and efficacy of lung cancer treatment, the epidemiology of lung cancer, and the tools available for obtaining a tissue diagnosis have significantly increased the complexity of this task over the last 20 years
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