What are the ACCP diagnostic guidelines for pleural abnormalities in non–small cell lung cancer (NSCLC)?

Updated: Jul 15, 2021
  • Author: Winston W Tan, MD, FACP; Chief Editor: Nagla Abdel Karim, MD, PhD  more...
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The updated ACCP guidelines recommendations for diagnosis of pleural abnormalities include the following [81] :

  • The least invasive and safest method (bronchoscopy with transbronchial needle aspiration, endobronchial ultrasound-guided needle aspiration, endoscopic ultrasound-guided needle aspiration, transthoracic needle aspiration, or mediastinoscopy) should be used to establish a diagnosis in individuals who have extensive infiltration of the mediastinum based on radiographic studies and no evidence of extrathoracic metastatic disease (negative positron emission tomography scan)

  • For individuals who have a solitary extrathoracic site suspicious of a metastasis, tissue confirmation of the metastatic site is recommended if a fine-needle aspiration (FNA) or biopsy of the site is feasible

  • In individuals in whom biopsy of a metastatic site would be technically difficult, it is recommended that diagnosis of the primary lung lesion be obtained by the least invasive method

  • In patients suspected of having lung cancer who have an accessible pleural effusion, ultrasound-guided thoracentesis is recommended to diagnose the cause of the pleural effusion

  • If pleural fluid cytology is negative, pleural biopsy (via image-guided pleural biopsy, medical or surgical thoracoscopy) is recommended as the next step

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