Introduction

The current practice of thoracic pathology extends beyond the routine pathological assessment of a pulmonary specimen and requires teamwork with a multidisciplinary approach. All pathologists – whether practicing in smaller community settings or in a larger academic centers – should facilitate an interactive discussion with their clinical and radiology colleagues. This should occur frequently, as technological advances are made, and as important evidence-based studies are added to the literature. This discussion has utility in all phases of the diagnostic evaluation – before, during, and after the specimen has been submitted to the laboratory. Reluctance on the part of the pathologist to engage in these discussions is often a disservice to the individual patient and an impediment to improving the overall quality of medical care and knowledge. Prior to sampling, the issue might center on what constitutes appropriate pathological sampling and in what context. Is an open lung biopsy necessary in a patient with idiopathic pulmonary fibrosis (IPF)? Given the current trend toward personalized chemotherapy requiring numerous molecular tests, will the amount of material in a needle biopsy be sufficient for diagnosis? Are multiple molecular tests in patients with advanced-stage non-small cell lung cancer needed and if so which ones? Under what circumstances is a cytological diagnosis of mesothelioma reliable and acceptable? During pathological evaluation, clinical and radiographic correlations are absolutely essential. Is the pathological sampling truly representative of the radiographic abnormality? Do the pathological changes account for the patient's symptoms and suspected disease? How can additional ancillary tests, such as immunohistochemistry, help to refine the diagnosis? As a corollary, why is it important for the clinician and patient to wait beyond the usual turnaround time for the final diagnosis? Following the final diagnosis, the discussion might focus on the options for further pathological sampling in the case of a non-diagnostic sampling, as well as the appropriate interval for radiographic follow-up and repeat sampling in stable or progressive disease.