Diagnostic procedures for non-small-cell lung cancer (NSCLC): recommendations of the European Expert Group

Abstract

BackgroundThere is currently no Europe-wide consensus on the appropriate preanalytical measures and workflow to optimise procedures for tissue-based molecular testing of non-small-cell lung cancer (NSCLC). To address this, a group of lung cancer experts (see list of authors) convened to discuss and propose standard operating procedures (SOPs) for NSCLC.MethodsBased on earlier meetings and scientific expertise on lung cancer, a multidisciplinary group meeting was aligned. The aim was to include all relevant aspects concerning NSCLC diagnosis. After careful consideration, the following topics were selected and each was reviewed by the experts: surgical resection and sampling; biopsy procedures for analysis; preanalytical and other variables affecting quality of tissue; tissue conservation; testing procedures for epidermal growth factor receptor, anaplastic lymphoma kinase and ROS proto-oncogene 1, receptor tyrosine kinase (ROS1) in lung tissue and cytological specimens; as well as standardised reporting and quality control (QC). Finally, an optimal workflow was described.ResultsSuggested optimal procedures and workflows are discussed in detail. The broad consensus was that the complex workflow presented can only be executed effectively by an interdisciplinary approach using a well-trained team.ConclusionsTo optimise diagnosis and treatment of patients with NSCLC, it is essential to establish SOPs that are adaptable to the local situation. In addition, a continuous QC system and a local multidisciplinary tumour-type-oriented board are essential.

Diagnostik des Lungenkarzinoms

“…Weitere fünf Zangenbiopsien oder alternativ zwei Kryobiopsien können die diagnostische Aussagefähigkeit weiter erhöhen [5].…”

“…Es werden zwei Stanzbiopsien empfohlen. Um mehr Gewebe zur immunhistochemischen und molekularen Diagnostik zu gewinnen, sollten nach Risikoabwägung 3-6 Stanzen in Betracht gezogen werden [5].…”

“…8 Über endoskopischen Ultraschall (EUS) gesteuerte Nadelaspiration einer Nebenniere links. Die Reflexion der Nadel ist in der Nebenniere gut sichtbar Abb 5. 8 Radialer endobronchialer Ultraschall in einem peripheren Rundherd.…”

Non-small cell lung cancer biomarkers and targeted therapy - two faces of the same coin fostered by nanotechnology

“…Several techniques are applied in NSCLC for diagnosis and staging, such as computed tomography (CT) scan of lower neck, thorax, and upper abdomen; sputum cytology; biopsy sample collection; and endobronchial ultrasound-guided transbronchial needle aspiration (EBS-TBNA) (for further information about these techniques and diagnostic procedures recommendations for NSCLC, see [8][9][10]). The poor accuracy of some of these methods prevent early NSCLC detection and, thus, most patients are diagnosed in advanced NSCLC and unresectable disease, reducing the effectiveness of therapeutics [10].…”

Sample types applied for molecular diagnosis of therapeutic management of advanced non-small cell lung cancer in the precision medicine

“…It is known that 90% of patients with early stage NSCLCs who receive surgical resections or have locally advanced NSCLCs and receive definitive chemoradiation, eventually relapse [22]. After about a year of remission, most advanced lung cancers treated with TKIs acquire resistance, hence demonstrating that the main mutations develop earlier and the subclonal mutations later [23,24]. Therefore, it is necessary to conduct repeat biopsies during the entire course of progression of NSCLCs, which would provide critical evidence for developing further treatment strategies.…”