Tissue diagnosis: histopathology, cytology and biopsy techniques

At a glance

• Tissue first, then stage, then biomarkers, then MDT. Almost every cancer treatment decision needs a histological diagnosis. Exceptions are rare: hepatocellular carcinoma in cirrhosis meeting LI-RADS imaging criteria, and some patients too frail for any treatment.
• Biopsy the lesion that gives the highest stage with the least risk: a supraclavicular node or liver lesion before a central lung primary.
• Plan for biomarkers at the first biopsy. Ask for cores, not FNA, when targeted therapy is likely (lung adenocarcinoma, metastatic breast, colorectal, melanoma).