Metastatic Non–Small Cell Lung Cancer Clinical Practice Guidelines (2018)

European Society for Medical Oncology

Reviewed and summarized by Medscape editors

November 02, 2018

The guidelines on metastatic non–small cell lung cancer (NSCLC) were released on October 3, 2018, by ESMO.[1]


Bronchoscopy is ideally suited for evaluation of central lesions and can be used with bronchial washing, brushing, and bronchial and transbronchial biopsy.

Endobronchial ultrasound (EBUS) and/or endoscopic ultrasound (EUS) can be used to evaluate regional lymph nodes.

Transthoracic fine needle aspiration and/or core biopsy, with passage of the needle through the parenchyma under imaging guidance (typically CT), is indicated in case of mid to peripheral lesions.

In patients with pleural effusion, thoracentesis could represent both a diagnostic tool and a palliative treatment.   

If an accurate diagnosis cannot be established with the above-listed techniques, more-invasive, surgical approaches (eg, mediastinoscopy, mediastinotomy, thoracoscopy) can be considered.

With systematic collaboration and constant communication between pathologists and the clinicians who perform the procedures, diagnostic yields will be significantly greater than with blind biopsies.


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