Chest
Volume 123, Issue 1, Supplement, January 2003, Pages 129S-136S
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Diagnosis of Lung Cancer*: The Guidelines

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Lung cancer is usually suspected in individuals who have abnormal chest radiograph findings or have symptoms caused by either local or systemic effects of the tumor. The method of diagnosis of suspected lung cancer depends on the type of lung cancer (ie, small cell lung cancer or non-small cell lung cancer), the size and location of the primary tumor, the presence of metastasis, and the overall clinical status of the patient. Achieving a diagnosis and staging are usually done in concert because the most efficient way to make a diagnosis often is dictated by the stage of the cancer. The best sequence of studies and interventions in a particular patient involves careful judgment of the probable reliability of a number of presumptive diagnostic issues, so as to maximize the sensitivity and to avoid performing multiple or unnecessary invasive procedures. In this article, we consider all manner of clinical presentations of lung cancer in light of currently available diagnostic procedures. Published data supporting a particular diagnostic approach is weighed based on the quality of the benefit as well as the estimated net benefit. Recommendations are graded in terms of strength to provide clinicians with guidance as to the most efficient and approach to the diagnosis of lung cancer in individual patients.

Section snippets

Recommendations

  • 1.

    In patients suspected of having SCLC based on the radiographic and clinical findings, the diagnosis should be obtained by whatever method is easiest (ie, sputum cytology, thoracentesis, FNA, or bronchoscopy, including TBNA), as dictated by the patient's presentation. Level of evidence, fair; benefit, moderate; grade of recommendation, B

  • 2.

    In patients suspected of having lung cancer who have an accessible pleural effusion, a definitive diagnosis of the pleural effusion via thoracentesis should be

Diagnosis of Primary Tumor

A variety of techniques (eg, sputum cytology, flexible bronchoscopy, and TTNA) are available as methods of achieving a definitive diagnosis. The selection of the most appropriate test is best performed in a multidisciplinary fashion. Four key questions on the diagnostic workup of patients with lung cancer were formulated and answered by a comprehensive review of the published literature performed by the Duke University Center for Clinical Health Policy Research. (Please refer to a previous

Conclusion

A variety of techniques is available to assist the clinician 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, chest radiologist, and thoracic surgeon. Furthermore, the most appropriate test is usually determined by the type of lung cancer (ie, SCLC or NSCLC), the size and location of the tumor, and the presumed stage of the cancer.

A diagnosis should be obtained by whatever

General Approach to Diagnosis

  • 1.

    In patients suspected of having SCLC based on the radiographic and clinical findings, the diagnosis should be obtained by whatever method is easiest (ie, sputum cytology, FNA, and bronchoscopy, including TBNA), as dictated by the patient's presentation. Level of evidence, fair; benefit, moderate; grade of recommendation, B

  • 2.

    In patients suspected of having lung cancer who have an accessible pleural effusion, a definitive diagnosis of the pleural effusion via thoracentesis should be made first.

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