What are the ACCP recommendations for the diagnosis of primary tumor in lung cancer?

Updated: Jul 15, 2021
  • Author: Winston W Tan, MD, FACP; Chief Editor: Nagla Abdel Karim, MD, PhD  more...
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Answer

The updated ACCP guidelines recommendations for diagnosis of primary tumor include the following [81] :

  • If lung cancer is suspected and sputum cytology is negative for carcinoma, further testing should be performed

  • In patients who have a central lesion, bronchoscopy should be used to confirm the diagnosis; further testing should be performed if bronchoscopy results are non-diagnostic and suspicion of lung cancer remains

  • As an adjunct imaging modality when a tissue sample is required due to diagnostic uncertainty or poor surgical candidacy, radial endobronchial ultrasonography can confirm in real time the ideal location of bronchoscopic sampling and increase the diagnostic yield over conventional bronchoscopy for peripheral nodules

  • With peripheral lung lesions difficult to reach with conventional bronchoscopy, electromagnetic navigation guidance can be used if the equipment and the expertise are available; if electromagnetic navigation is not available, transthoracic needle aspiration (TTNA) is recommended

  • In patients who have a peripheral lesion, and who require tissue diagnosis before further management can be planned, TTNA is diagnostic option; however, further testing should be performed if TTNA results are non-diagnostic and suspicion of lung cancer remains

  • The diagnosis of non–small cell lung cancer (NSCLC) made on cytology (sputum, TTNA, bronchoscopic specimens, or pleural fluid) is reliable. However, adequate tissue must be obtained to accurately define the histologic type and to perform molecular analysis when applicable.


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