Topics in Pulmonary MedicineChallenges and Opportunities for Identifying Non–Small Cell Lung Cancer Biomarkers Using BronchoscopyDotson, Travis MD*,†; Ruiz, Jimmy MD†,‡; Petty, W. Jeffrey MD†,‡ Author Information *Section on Pulmonary & Critical Care Medicine, Department of Medicine ‡Section on Hematology and Oncology, Department of Medicine †Wake Forest School of Medicine, Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC Supported by Cancer Center Support Grant P30 CA12197 from the National Cancer Institute. Disclosure: The authors declare no conflicts of interest. Address correspondence to: Travis Dotson, MD, Section on Pulmonary & Critical Care Medicine, Department of Medicine, Wake Forest School of Medicine, Comprehensive Cancer Center of Wake Forest University, Medical Center Boulevard, Winston-Salem, NC 27157. E-mail: [email protected]. Clinical Pulmonary Medicine: January 2015 - Volume 22 - Issue 1 - p 36-41 doi: 10.1097/CPM.0000000000000076 Buy Metrics Abstract Non–small cell lung cancer is no longer viewed as a single disease, but a constellation of cancer types that benefit from different treatments. Advancements in the identification of driver mutations with specific Food and Drug Administration–regulated molecular tests have been approved for matching the right treatment to the right patient. These biomarkers, referred to as theranostic biomarkers, because of their ability to support treatment decisions and predict a clinical response are changing the way oncologists formulate non–small cell lung cancer treatment plans. Currently approved biomarker tests for lung cancer include fluorescence in situ hybridization testing for genetic rearrangements and reverse-transcriptase polymerase chain reaction testing for genetic mutations. As the use of molecular medicine progresses, an emerging treatment challenge in thoracic oncology is using limited cytologic material to reliably measure the essential theranostic biomarkers. The majority of newly diagnosed lung cancer patients have advanced disease at the time of presentation, and often undergo the least invasive biopsy possible to ascertain a diagnosis and disease stage. As less invasive diagnostic techniques become more common, it is critical to optimize collection and minimize loss of cancer tissue during processing. The physicians performing these procedures must be knowledgeable about tissue requirements for molecular testing based on tumor type, and should develop collection strategies to optimize molecular biomarker testing. This review explores current literature recommendations to maximize the collection and processing of cytology material for biomarker evaluation and evaluate which cytology samples provide the best yields. As our ability to truly individualize lung cancer therapy evolves, it will be critical to reliably evaluate and treat based on biomarker analysis. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.