The changing diagnostic pathway for lung cancer patients in Shanghai, China.

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.