Lung cancer cytology and small biopsy specimens: diagnosis, predictive biomarker testing, acquisition, triage, and management

J Am Soc Cytopathol. 2020 Sep-Oct;9(5):332-345. doi: 10.1016/j.jasc.2020.04.014. Epub 2020 May 28.

Abstract

In the 21st century, there has been a dramatic shift in the management of advanced-stage lung carcinoma, and this has coincided with an increasing use of minimally invasive tissue acquisition methods. Both have had significant downstream effects on cytology and small biopsy specimens. Current treatments require morphologic, immunohistochemical, and/or genotypical subtyping of non-small cell lung carcinoma. To meet these objectives, standardized classification of cytology and small specimen diagnoses, immunohistochemical algorithms, and predictive biomarker testing guidelines have been developed. This review provides an overview of current classification, biomarker testing, methods of small specimen acquisition and triage, clinical management strategies, and emerging technologies.

Keywords: Biomarkers; Cytology; Emerging technologies; Lung cancer; Molecular testing; Small biopsy.

Publication types

  • Review

MeSH terms

  • B7-H1 Antigen / genetics
  • Biomarkers, Tumor
  • Biopsy, Fine-Needle / methods
  • Biopsy, Large-Core Needle / methods
  • Carcinoma, Non-Small-Cell Lung / classification
  • Carcinoma, Non-Small-Cell Lung / diagnosis*
  • Carcinoma, Non-Small-Cell Lung / genetics
  • Carcinoma, Non-Small-Cell Lung / pathology
  • High-Throughput Nucleotide Sequencing / methods
  • Humans
  • Lung Neoplasms / classification
  • Lung Neoplasms / diagnosis*
  • Lung Neoplasms / genetics
  • Lung Neoplasms / pathology
  • Mutation
  • Neuroendocrine Tumors / classification
  • Neuroendocrine Tumors / diagnosis*
  • Neuroendocrine Tumors / genetics
  • Neuroendocrine Tumors / pathology
  • Precision Medicine / methods*
  • Triage / methods*

Substances

  • B7-H1 Antigen
  • Biomarkers, Tumor
  • CD274 protein, human