Diagnosis of lung cancer requires both visualization of the cancerous lesion and tissue sampling for pathologic assessment. Visualization of the suspected tumor provides the clinician with the information necessary to choose the most appropriate sampling technique. While some lung tumors may be apparent using relatively simple techniques such as a chest x-ray (CXR), many can be too small to detect or may be located in an anatomically difficult area to visualize. Therefore, multiple methods of visualization are often used. Once the tumor has been located, sampling provides tissue to confirm malignancy and to determine the histology (e.g., squamous cell, adenocarcinoma, large cell, or small cell). The advantages and disadvantages of various sampling methods must be weighed carefully so that the procedure performed is the least invasive with a high likelihood of providing an accurate diagnosis. Tools used in the diagnosis of lung cancer are outlined in Table 90-1.

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