Principles of biopsy in suspected lung cancer: priority still based on invasion in the era of targeted therapy?

There are multiple ways to obtain a biopsy for patients with suspected lung cancer under clinical circumstances. Diagnostic goals described previously in literature should be achieved preferably by using the safest, least invasive, and least costly biopsies. Insight into molecular profile and era of targeted therapy challenged the previous concepts on tumor biopsy. Distinct principles of biopsy should be revisited to adopt the advances in clinical research. A 53-year-old gentleman with 10-year history of dust exposure consulted to our hospital because of bloody sputum. PET/CT scanning revealed a 3.2-centimeter mass with an increased (18)F-FDG uptake in right upper lung lobe, metabolically active lesions in multiple stations of mediastinal or bilateral hilar lymph nodes and an intramuscular nodule in the left gluteus maximus. He underwent transthoracic core needle biopsy of the lung mass, resection of intramuscular nodule, bronchoscopy and right upper lung lobectomy in sequence. The final diagnosis was considered as systemic lipid deposition. Principles of biopsy in suspected lung cancer should be prioritized in sequence based on weight in clinical management, acquisition of tissue, invasion, efficiency and cost.