Multidisciplinary international expert consensus recommendations on tissue acquisition in non-small cell lung cancer.

[BACKGROUND] The practice of precision medicine has transformed outcomes for patients with advanced non-small cell lung cancer (NSCLC). Precision medicine is increasingly applied to the therapeutic algorithms of early-stage NSCLC both in the neoadjuvant and adjuvant space. Procuring sufficient tumour specimens safely and preparing tissue are key components. Whilst there are guidelines on how to optimise tissue acquisition and handling, real-world practice identifies wide variation in diagnostic yields and procedural complication rates, which underscores the need for a consensus-driven multidisciplinary approach.

[METHODS] This article reflects the collective consensus of an international expert panel of different specialities from the United States, Europe, and Asia-Pacific regions. Consensus recommendations were developed following a structured virtual working group discussion, during which the group shared recommendations for tissue acquisition and initial handling. The manuscript was finalised through successive rounds of offline review until consensus was achieved.

[FINDINGS] The site of involvement that denotes the most advanced stage should be chosen for biopsy. The choice of technique should depend on where the tissue is acquired from, e.g., pulmonary nodules, intra-thoracic lymph nodes, tissue in advanced stage disease, or pleural disease.

[INTERPRETATION] The optimal biopsy technique should support simultaneous diagnosis and staging and be selected based on the patient's clinical presentation, the expected diagnostic yield, the required sample type, and the degree of invasiveness, while maintaining a patient-centred approach.

[FUNDING] AstraZeneca.