89 experts. 96 statements. Here is what they actually agreed on. 🧠

A modified Delphi process brought 89 thoracic oncology experts together for a 3-day in-person meeting in Barcelona last September. They rated 96 clinical statements on non-metastatic NSCLC. According to the Journal of Thoracic Oncology, consensus was achieved for 62 of those statements, 31 remained without consensus, and 3 were rejected outright.

That means 1 in 3 statements could not reach agreement among the world’s leading thoracic oncology minds.

This is the most honest document in thoracic oncology right now. Not a guidelines memo. A real snapshot of where the field stands.

Here is what the consensus actually said, by domain.

📋 THE NSCLC CONSENSUS CHECKLIST: AGREED vs. CONTESTED

WHAT THE EXPERTS AGREED ON:
🔹Routine FDG PET-CT for staging
🔹Histologic confirmation of suspicious mediastinal nodes
🔹Reflex PD-L1 testing at diagnosis
🔹DNA-based next-generation sequencing at diagnosis
🔹Standardized post-neoadjuvant pathologic assessment
🔹Sublobar resection with systematic nodal evaluation for selected peripheral node-negative tumors 2 cm or smaller
🔹Consolidation durvalumab after definitive chemoradiotherapy for unresectable stage II-III disease, irrespective of PD-L1 expression

❌ WHERE CONSENSUS BROKE DOWN:
– Brain MRI in stage I disease
– Mediastinal restaging after induction therapy
– Routine RNA-based testing
– Using circulating tumor DNA or minimal residual disease to guide perioperative decisions

The contested areas are not minor edge cases. They are decisions your tumor board is making right now.

🔎 HOW TO APPLY THIS AT YOUR INSTITUTION

Step 1. Pull your last 10 non-metastatic NSCLC cases. Did every patient get FDG PET-CT, reflex PD-L1, and DNA-based NGS at diagnosis? If not, that is a workflow gap, not a judgment call.

Step 2. For your stage I patients: do you have a written local protocol on brain MRI? The experts could not reach consensus here. Your team needs its own position.

Step 3. For patients who received induction therapy: what triggers mediastinal restaging at your center? Contested ground means you need a standard, because the guidelines will not give you one.

Save this post. Print this checklist. Bring it to your next tumor board.

The field gave us 64% consensus. The other 36% is yours to own.

Most teams treat contested evidence as a reason to delay decisions. The strongest teams treat it as a reason to build institutional protocols.

That is the difference between a multidisciplinary tumor board and a real multidisciplinary program.

👉 Follow Jonathan Govette, CEO of Oatmeal Health, for daily healthcare insights on LinkedIn. Deeper dives in The Oatmeal Bite on Substack: https://news.oatmealhealth.com

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