In clinically metastatic lung cancer with bone predominant disease, do you routinely biopsy the bone to prove metastatic involvement, knowing that bone biopsies are generally not ideal for molecular testing?   

If patients have diffuse disease, I do not biopsy bone lesions to confirm bone involvement if imaging studies are very suggestive. I do refer patients with an otherwise local or locoregional disease with bone lesion that is suspicious, since that would change the stage and management.

In general, I do try to prove metastatic disease especially if this is initial diagnosis or in the setting of disease recurrence after curative treatment. If you plan ahead and discuss with your pathologist, sometimes they can change the processing to allow for DNA testing though this might not be a...

I try to prove metastatic disease pathologically at initial diagnosis or in the setting of disease recurrence after curative treatment. If the bone lesions are the only site of mets, I discuss with radiology to biopsy the bony lesion with soft tissue, if possible, to send to NGS. If no soft tissue a...