Dr. Mercado on Evolution of Biopsy Techniques in Lung Cancer

Jorge M. Mercado, MD, clinical associate professor, Department of Medicine, NYU Grossman School of Medicine, NYU Langone Health’s Perlmutter Cancer Center, associate section chief, Pulmonary, Critical Care & Sleep Medicine, NYU Langone Hospital-Brooklyn, discusses the evolution of biopsy techniques in patients with lung cancer.

Advances in biopsy techniques have allowed for improved access to patients’ lungs, allowing for more accurate and less intrusive ways to diagnose lung cancer, Mercado explains. Compared with other solid tumor types, accessing lesions to biopsy for potential lung cancer presented a unique challenge. When conducting biopsies for other organs such as the kidney, liver, or skin, accessing lesions was accompanied with fewer obstacles, particularly for early lesions.

For example, imaging can be used to detect and diagnose breast cancer, which is sometimes detectable on palpation imaging; however, imaging is not a viable method for diagnosing lung cancer, according to Mercado, adding that the detection of pulmonary nodules or masses does not always translate into a diagnosis of lung cancer. When nodules or masses are detected, the most important thing to consider is whether a biopsy is the best course of action to obtain a tissue sample, Mercado explains.

For many years, clear techniques to conduct lung biopsies were not readily available, Mercado notes. Bronchoscopes, which are similar, but smaller, versions of scopes that are used for gastrointestinal procedures, presented one option for biopsies; however, these tools limited biopsies to the center of the lungs, as they were unable to reach certain areas on the periphery of the lungs.

Considering the majority of nodules are located on the periphery of the lungs, this presented the main challenge with bronchoscopes, Mercado notes. With recent advancements, such as robotic-assisted bronchoscopies, accessing these nodules and the periphery of the lungs in a less invasive way is more realistic, Mercado concludes.