A Focus on the Role of Patient Navigators in the Diagnosis and Management of Early-Stage NSCLC

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Diagnostic Workup for Resectable NSCLC: An MDT Approach

Initial Evaluation and Clinical Assessment

• Patient History and Physical Examination:
  • Assess risk factors (eg, smoking history, occupational exposures, family history).
  • Evaluate symptoms (cough, hemoptysis, weight loss, dyspnea, chest pain).
• Imaging Studies:
  • Chest CT with contrast: Identifies tumor size, location, and possible nodal involvement.
  • PET-CT scan: Performed for staging to assess local invasion, nodal disease, and distant metastases.
  • Brain MRI (if indicated): For patients with neurological symptoms or advanced disease suspicion.

Tissue Diagnosis and Staging

• Bronchoscopy With Endobronchial Ultrasound or Endoscopic Ultrasound:
  • Used for cytological or histological sampling of mediastinal lymph nodes.
• CT-Guided Percutaneous Biopsy:
  • Considered when lesions are peripherally located or inaccessible via bronchoscopy.
• Surgical Biopsy (if needed):
  • Occasionally required for diagnostic confirmation in ambiguous cases.
• Mediastinal Staging:
  • Essential to determine nodal involvement before proceeding to surgery.

Molecular and Biomarker Testing

• Timing of Molecular Testing:
  • Initiated at the time of biopsy or immediately after pathological confirmation of NSCLC
  • Expedient processing is critical to guide adjuvant or neoadjuvant therapy decisions
• Key Molecular Markers in Resectable NSCLC:
  • EGFR mutations
  • ALK rearrangements
  • ROS1, BRAF, MET, RET, and KRAS mutations (if applicable)
  • PD-L1 expression (via immunohistochemistry, particularly relevant for immunotherapy)
• Testing Methods:
  • Next-generation sequencing (NGS) is the preferred method for comprehensive profiling.
  • Polymerase chain reaction or fluorescent in situ hybridization may be used for individual mutations if NGS is unavailable.

MDT Discussion and Treatment Planning

• Surgical Assessment:
  • Considered for stage I-II and selected stage IIIA NSCLC based on staging workup.
  • Lobectomy is the preferred approach; segmentectomy may be used in select cases.
• Neoadjuvant or Adjuvant Therapy:
  • Neoadjuvant chemoimmunotherapy may be considered for resectable stage II/III disease.

• Adjuvant therapy (chemotherapy, targeted therapy, or immunotherapy) is guided by molecular findings.

• Radiation Oncology Consultation:
  • Indicated if surgical margins are positive or if surgery is not feasible.

Postoperative Follow-Up and Surveillance

• Regular imaging (CT scans at defined intervals)
• Molecular testing updates if recurrent disease is suspected
• Ongoing MDT evaluations to adapt treatment as necessary

This streamlined diagnostic approach ensures that molecular testing is integrated early, allowing for timely and personalized treatment decisions for patients with resectable NSCLC.