Workup and Molecular Testing for a Patient with NSCLC


David H. Harpole Jr, MD, a thoracic surgeon, details his workup approach and discussed molecular testing for patients who present with NSCLC.


David Spigel, MD: David, I’m curious. When I started almost 20 years ago out of training, I remember the surgeons I worked with and they were great. Their advice was, if it’s a solitary lesion, just take it out, don’t even bother biopsying it. Of course, back then we were just learning how to do PET [positron emission tomography] scans. [Discuss] your thoughts on how a patient who comes to you at Duke [University Medical Center] approaches with a solitary lesion. What are you doing? Are you doing a PET scan? If I’m not mistaken, I think you do your own scopes, but could you expand on your approach to the workup of a solitary lesion?

David H. Harpole Jr, MD: It has certainly evolved, and frankly, most rapidly over the last 2 to 4 years. As this wave is moving across the country and things are changing, I will tell you, we were a universal mediastinoscopy center for everyone. I used to do literally 300 or 400 a year, and now I do like 15…. I think the EVIS EXERA III platform that we use, and interventional pulmonary uses, has supplanted that. I will say that with the robotic platforms now, I think that has been our primary [procedure] as well. The reason being is that historically, [with] a 2-cm lesion like this that’s suspicious, we would’ve just taken it out without a diagnosis. We can go more into about the size and what we find, but certainly lesions greater than 3 cm where there are some other options now, we have been getting not only cytology but histology and molecular information on them, and we’re going to obviously discuss that more.

This [case] is pretty much a straightforward T1 lesion that I would say probably half of the thoracic surgeons now would take out without a diagnosis. We tend to get a diagnosis now more than we used to, and I think it has killed 2 birds with 1 stone because with EVIS EXERA III and our navigational [bronchoscopy], we can get a tissue diagnosis of the lesion as well as the nodal stations at the same time. This is truly a team [effort], and I think our interventional pulmonary team has become even more important to that.

Transcript edited for clarity.

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