Initial evaluation of the nonsmall cell lung cancer patient: Diagnosis and staging

Purpose of review: The initial diagnosis and staging of nonsmall cell lung cancer patients is complex and involves multiple technologies. This review evaluates the recent literature and integrates it into a systematic method for evaluating patients. Recent findings: The goal of the initial diagnosis and staging of nonsmall cell lung cancer is to provide sufficient information to allow definitive treatment. Initial steps should include a history and physical, basic laboratory tests, pulmonary functions, and PET-computed tomography (CT) imaging. If there is evidence of metastatic disease, then biopsy of the most advanced lesion is warranted. If there is no evidence of metastatic disease, the evaluation should focus on evaluation of the mediastinal lymph nodes. If there is evidence of nodal involvement by PET-CT, then endobronchial ultrasound-guided transbronchial needle aspiration is warranted. If there is no evidence of nodal involvement on PET-CT, then either surgery or CT-guided fine needle aspiration is warranted. Other factors that should be kept in mind when selecting a diagnostic strategy include whether or not the patient is a surgical candidate, the impact of comorbidities, the type of cancer, the need for predictive biomarker analysis, and the range of possible treatment options. Summary: Integrating new technologies such as PET-CT and endobronchial ultrasound into the initial evaluation of patients can save unnecessary diagnostic procedures and lead to more rapid and accurate staging.