Chest
Establishing the Diagnosis of Lung Cancer: Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
Section snippets
General Approach to Diagnosis
2.3.1. In patients suspected of having small cell lung cancer (SCLC) based on the radiographic and clinical findings, it is recommended that the diagnosis be confirmed by the least invasive method (sputum cytology, thoracentesis, fine needle aspiration [FNA], bronchoscopy including transbronchial needle aspiration [TBNA]), as dictated by the patient's presentation (Grade 1C).
2.3.2. In patients suspected of having lung cancer, who have extensive infiltration of the mediastinum based on
Methods
This article updates previous ACCP Lung Cancer Guidelines.19, 20 The data from these previous editions were included and updated as described later. Where new technology or procedures became available, new data summaries were developed. In addition, because of the increasing importance of distinguishing the cell type of NSCLC in the identification of genetic mutations, a discussion of how this impacts diagnostic procedures has been included.
In collaboration with an ACCP methodologist, the
Thoracentesis
Patients with suspected lung cancer who present with a pleural effusion should undergo thoracentesis. Cytologic examination of the pleural fluid is a quick and minimally invasive way to differentiate between a malignant effusion (due to malignant involvement of the pleura) and a paramalignant effusion (due to other factors such as lymphatic blockade, atelectasis, or hypoproteinemia). Distinction between the two has particular clinical relevance because the finding of malignant cells in the
Diagnosis of Primary Tumor
A variety of techniques (sputum cytology, FB, EMN bronchoscopy, R-EBUS, TTNA) are available as methods to establish a definitive diagnosis. The main goals in selecting a specific diagnostic modality are (1) to maximize the yield of the selected procedure for both diagnosis and staging and (2) to avoid unnecessary invasive tests for the patient, with special attention to the projected treatment plan. For the first edition of the ACCP Lung Cancer Guidelines, key questions were formulated to
Conclusion
A variety of techniques are available to assist the physician in achieving a definitive diagnosis of lung cancer. Selection of the most appropriate test is best done in a multidisciplinary fashion with input from a pulmonologist, a chest radiologist, a thoracic surgeon, and a pathologist. Furthermore, the most appropriate test is usually determined by the type of lung cancer (SCLC or NSCLC), the size and location of the tumor, and the presumed stage of the cancer.
A diagnosis should be obtained
Acknowledgments
Author contributions: Dr Rivera had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Dr Rivera: contributed to the writing of all sections and recommendations except for the navigation bronchoscopy and R-EBUS sections and recommendations; the evidence review for PICO questions 2, 3, 6, and 7 to update these sections; and the review and editing of the manuscript.
Dr Mehta: contributed to the writing of the
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Funding/Sponsors: The overall process for the development of these guidelines, including matters pertaining to funding and conflicts of interest, are described in the methodology article.1 The development of this guideline was supported primarily by the American College of Chest Physicians. The lung cancer guidelines conference was supported in part by a grant from the Lung Cancer Research Foundation. The publication and dissemination of the guidelines was supported in part by a 2009 independent educational grant from Boehringer Ingelheim Pharmaceuticals, Inc.
COI Grids reflecting the conflicts of interest that were current as of the date of the conference and voting are posted in the online supplementary materials.
Disclaimer: American College of Chest Physician guidelines are intended for general information only, are not medical advice, and do not replace professional medical care and physician advice, which always should be sought for any medical condition. The complete disclaimer for this guideline can be accessed at http://dx.doi.org/10.1378/chest.1435S1.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.