Table 2.
Summary of the diagnostic standards of care to guide appropriate investigations for suspected lung cancer7
| DSOC group | Key diagnostic and staging tests | Key physiological tests to assess fitness |
|---|---|---|
DSOC 1: Peripheral lesion with normal hilar and mediastinal appearance without distant metastases. | PET-CT Biopsy: percutaneous image guided or bronchoscopic guided (fluoroscopy, radial-EBUS, or navigation bronchoscopy) depending on location. Some MDTs may consider it appropriate to offer treatment without biopsy if high probability of malignancy. | Spirometry and transfer factor. Shuttle walk, 6MW or CPEX (omit if not surgical candidate). ECG. Echo if evidence of a murmur, abnormal ECG or cardiac history. |
DSOC 2: Lesion with mediastinal/hilar lymphadenopathy without distant metastases. | PET-CT Staging EBUS (±EUS). Biopsy of primary lesion if nodes true negative on EBUS/EUS. Contrast-enhanced CT of the brain if stage II OR contrast-enhanced MRI of the brain if stage III. | Spirometry and transfer factor. Shuttle walk, 6MW or CPEX (omit if not surgical candidate). ECG. Echo if evidence of a murmur, abnormal ECG or cardiac history. |
DSOC 3: Contiguous or conglomerate invasive mediastinal lymphadenopathy without distant metastases. | PET-CT EBUS (±EUS) or US-guided neck node biopsy if present. Contrast-enhanced MRI of the brain. | Spirometry and transfer factor. Renal function (for likely chemotherapy). |
DSOC 4: Evidence of distant metastases. | Choose the least invasive and safest sampling technique to yield adequate diagnosis. | Renal function (for likely chemotherapy). Spirometry optional depending on treatment possibilities. |
6MW = 6-minute walk test; CPEX = cardiopulmonary exercise testing; DSOC = diagnostic standard of care; ECG = electrocardiography; Echo = echocardiography; EBUS = endobronchial ultrasound; EUS = endoscopic ultrasound; MDT = multidisciplinary team; MRI = magnetic resonance imaging; PET-CT = positron emission tomography - computed tomography; US = ultrasound.