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Updated: Mar 22, 2026
Detection of Targetable Alterations in Non-small Cell Lung Cancer using Next-generation Sequencing
Published on: October 10, 2025
Multidisciplinary international expert consensus recommendations on tissue acquisition in non-small cell lung cancer
Pyng Lee1, Karim Abdelhamid2, Rachel Butler3
1Department of Medicine, National University of Singapore, Singapore.
Background:
The practice of precision medicine has transformed outcomes for patients with advanced non-small cell lung cancer (NSCLC). Precision medicine is increasingly applied to the therapeutic algorithms of early-stage NSCLC both in the neoadjuvant and adjuvant space. Procuring sufficient tumour specimens safely and preparing tissue are key components. Whilst there are guidelines on how to optimise tissue acquisition and handling, real-world practice identifies wide variation in diagnostic yields and procedural complication rates, which underscores the need for a consensus-driven multidisciplinary approach.
Methods:
This article reflects the collective consensus of an international expert panel of different specialities from the United States, Europe, and Asia-Pacific regions. Consensus recommendations were developed following a structured virtual working group discussion, during which the group shared recommendations for tissue acquisition and initial handling. The manuscript was finalised through successive rounds of offline review until consensus was achieved.
Findings:
The site of involvement that denotes the most advanced stage should be chosen for biopsy. The choice of technique should depend on where the tissue is acquired from, e.g., pulmonary nodules, intra-thoracic lymph nodes, tissue in advanced stage disease, or pleural disease.
Interpretation:
The optimal biopsy technique should support simultaneous diagnosis and staging and be selected based on the patient's clinical presentation, the expected diagnostic yield, the required sample type, and the degree of invasiveness, while maintaining a patient-centred approach.
Funding:
AstraZeneca.
Insights
Optimizing tissue acquisition for early-stage non-small cell lung cancer (NSCLC) is crucial. An international expert panel developed consensus recommendations for biopsy techniques to improve diagnostic yield and patient outcomes.
Area of Science:
- Oncology
- Thoracic Surgery
- Pathology
Background:
- Precision medicine has improved outcomes in advanced non-small cell lung cancer (NSCLC).
- Its application is expanding to early-stage NSCLC in neoadjuvant and adjuvant settings.
- Optimizing tissue acquisition and handling is critical for diagnostic yield and safety, with real-world practice showing significant variation.
Purpose of the Study:
- To establish consensus-driven recommendations for optimizing tissue acquisition and handling in early-stage NSCLC.
- To address the need for a multidisciplinary approach in real-world practice.
Main Methods:
- An international expert panel from diverse specialties participated in a structured virtual working group.
- Recommendations for tissue acquisition and initial handling were developed through group discussion.
- The manuscript was finalized through iterative offline review to achieve consensus.
Main Results:
- The biopsy site should target the most advanced stage of involvement.
- The choice of biopsy technique should be tailored to the specific site of tissue acquisition (e.g., pulmonary nodules, lymph nodes, pleural disease).
Conclusions:
- Optimal biopsy techniques should facilitate simultaneous diagnosis and staging.
- Technique selection must consider patient presentation, expected diagnostic yield, required sample type, and invasiveness.
- A patient-centered approach is essential in selecting the optimal biopsy strategy.
