ReviewThe changing diagnostic pathway for lung cancer patients in Shanghai, China

•The diagnosis, clinical staging and molecular phenotyping must be quick and efficient for lung cancer patients.•A median 4 working days for a new patient from initial respiratory consultation to treatment decision can be achieved.•To improve the speed of diagnosis and treatment decision of advanced lung cancer, we need to learn from each other.

Accumulating evidence suggest that patients with advanced non-small-cell lung cancer (NSCLC) and specific genomic alterations including epidermal growth factor receptor and microtubule-associated protein-like 4 anaplastic lymphoma kinase could significantly benefit from molecular-targeted therapies compared with chemotherapy. Recently, immunotherapy based on programmed cell death 1 (PD-1) and its ligand (PD-L1) blockade prolong survival in patients with advanced NSCLC, especially in those patients with positive expression of PD-L1 and when used in the first-line setting. Therefore, the diagnosis, clinical staging and molecular genotyping must be quick and efficient so that we can make a timely and precise decision for treatment strategy. In our department, it takes a median 4 working days (range 3-6) for a new patient from initial respiratory consultation to treatment decision, whereas in many countries, 14 workdays is considered a reasonable timeline. In this article, we will provide detailed information on the diagnostic pathway for a new patient suspected of having lung cancer to the final treatment decisions in our department.