Establishing the Diagnosis of Lung Cancer

Describe your topic.: We are suggesting the following PICO questions pertaining to Establishing the Diagnosis of Lung Cancer. 1. How do the test performances of closed, image-guided pleural biopsy and thoracoscopic pleural biopsy compare for evaluating pleural effusions for malignancy in patients with known or suspected lung cancer? 2. What are the performance characteristics of sputum cytology for the diagnosis of lung cancer, with special consideration for the location of the tumor? 3. What are the performance characteristics of flexible bronchoscopy (FB) and its ancillary procedures for the diagnosis of central (endobronchial) as opposed to peripheral tumors and peripheral tumors less than 2 and greater than 2 cm in size? 4. What are the performance characteristics of R-EBUS as a diagnostic modality for peripheral lung cancer? 5. What are the performance characteristics of EMN in the diagnosis of a PLL? 6. What are the performance characteristics of TTNA as a diagnostic modality, with particular emphasis on the size and location of the suspected cancer? 7. What is the diagnostic error when differentiating between NSCLC and SCLC generated by various diagnostic techniques (bronchoscopy, TTNA, and sputum cytology)?

Describe why this topic is important.: Approximately 75% to 80% of newly diagnosed lung cancers are non-small cell lung cancers (NSCLCs) (adenocarcinoma, large cell carcinoma, or squamous cell carcinoma). However, it is important to differentiate between NSCLC and small cell lung cancer (SCLC), as well as determine the disease stage, in order to determine the optimal treatment strategy. A variety of techniques are available to facilitate diagnosis, such as sputum cytology, conventional bronchoscopy, flexible bronchoscopy (FB), electromagnetic navigation (EMN) bronchoscopy, radial endobronchial ultrasound (R-EBUS)-guided lung biopsy, transthoracic needle aspiration (TTNA) or biopsy, pleural fluid cytology, and pleural biopsy. The main goals in selecting a specific diagnostic modality are (1) to maximize the yield of the selected procedure for both diagnosis and staging and (2) to avoid unnecessary invasive tests for the patient, with special attention to the projected treatment plan. As the science base for lung cancer diagnostics is evolving, an assessment of the current evidence-based is needed to determine the test performance characteristics of various modalities for the diagnosis of lung cancer and to assist physicians in determining ideal diagnostic options for this set of patients.

Tell us why you are suggesting this topic.: Lung Cancer Staging has been the focus of 3 editions of evidence-based guidelines developed by the American College of Chest Physicians (CHEST), the last of which was published in 2013 and accepted by the National Guideline Clearinghouse. CHEST aims to update its guidelines every 5 years per the National Academy of Medicine (formerly IOM) and AHRQ standards, but due to increased demand for guidelines, has fallen short on this objective. Development of an evidence review on at least some, if not all, of the PICO’s described above would serve as the source document to facilitate the update of these guidelines.

Describe what you are doing currently and what you are hoping will change because of a new evidence report.: Evidence reports form the basis of all CHEST clinical practice guidelines. If this topic is selected for an AHRQ evidence report, the results of that report will directly inform an update of the guideline on Establishing the Diagnosis of Lung Cancer. The original selection of this topic was due to professional demand based on inconsistent or lack of clear guidance based on current evidence. CHEST guidelines have been touted as a useful tool to assist in clinical decision-making, resulting in improved concordance between practice and the larger body of published evidence. In order to meet the National Academy of Medicine (formerly IOM) standards, it is imperative that an updated evidence report be developed to update the guidelines.

How will you or your group use the information from a new evidence report?: The evidence report will be directly used to inform the update of evidence-based guidelines on this topic.

How would you or your group plan to disseminate information from the report? Who would you plan to disseminate it to?: The report will be disseminated in the following ways: 1) communications to CHEST membership (nearly 19,000 healthcare providers) via electronic (ie eNews Alerts), print (ie CHEST Physician Newsletter), and social media. There will also be opportunities to inform providers about the report through our eLearning and Live Learning platforms, including our Annual Conference. Finally, the report will be referenced as the source document for the subsequent update of the guideline, furthering dissemination of the report as well as use of its contents in clinical practice.

Do you know of organizations that could use an evidence report to change clinical practice? Are you a part of, or have you been in contact with, any organizations that might implement the research findings of an evidence report?: CHEST serves as the primary organization that will directly use this evidence report to update our clinical practice guideline on Establishing the Diagnosis of Lung Cancer. Such guidelines have the opportunity to change clinical practice by improving clinical decisions in concordance with current evidence. Other organizations that would also benefit from this evidence report include: the American Thoracic Society, the American Society for Clinical Oncology and the American Lung Association.

Information About You: (optional)

Provide a description of your role or perspective.: The American College of Chest Physicians (CHEST) is a professional society, and is the global leader in advancing best patient o

If you are you making a suggestion on behalf of an organization, please state the name of the organization.: American College of CHEST Physicians

Please tell us how you heard about the Effective Health Care Program.: CHEST has collaborated with AHRQ in the past on evidence reviews, most recently the Venous Thromboembolism Prophylaxis in Orthop

Effective Health Care Program