Démarche diagnostique dans le cancer bronchique : diagnostic positif et bilan d'extension

The diagnostic work-up of suspected lung cancer has two aims : provide a definite (histological) diagnosis, and assess the extent of the disease so that a reliable clinical TNM staging (cTNM) can be determined. Both elements, diagnosis and cTNM, will constitute the main bases for the initial therapeutic decisions, only altered by individual clinical considerations and eventual co-morbidities. For rare selected patients, the histological diagnosis may be only obtained at surgery, which becomes both a diagnostic and curative procedure. By contrast, the pre-therapeutic determination of a reliable cTNM staging must not tolerate any exception. The quality of this evaluation will impact treatment relevance and results, which can be measured in terms of survival and quality of life.