Choosing Between Tissue and Liquid Biopsy and the Breadth of Testing for Lung Cancer

This segment focuses on how clinicians decide between tissue biopsy and blood based testing when planning initial genomic evaluation. Dr Singhal describes how patient factors such as tumor location, disease burden, and the feasibility of obtaining a tissue sample guide this decision. The panel explains that while tissue remains the standard starting point for many patients, liquid biopsy can be valuable when tissue is limited, unsafe to obtain, or insufficient for broad molecular profiling. The experts also discuss the difference between narrow testing for a few common actionable genes and broad next generation sequencing panels that interrogate hundreds of alterations. They note that narrow testing can miss rare drivers and gene fusions, especially those present at low levels, which may deprive patients of effective targeted options. At the same time, they acknowledge that broader panels require careful interpretation and appropriate clinical context. This exchange highlights the balance clinicians must strike between speed, breadth, and clinical practicality when choosing a testing strategy. The panel reinforces that using comprehensive testing early improves the chance of identifying the right therapy on the first attempt.