Prof. Al-Hajjaj graduated from King Saud University Medical College in 1981 and obtained The American board of Internal Medicine in 1986, Certificate of “Fellow of the Royal College of Physician and Surgeons of Canada” (FRCP (C) in 1987 and The “American Board of Respiratory Diseases” in 1988.  He has been a Professor of Medicine and Pulmonology since 2002.  His research interest is in the field of bronchial asthma and COPD. Professor Al-Hajjaj has published more than 60 research papers in the medical literature.  Currently he is the Vice-Dean of College of Medicine, UOS, UAE, and the Chairman of the Saudi Thoracic Society.


Background:Accurate pathological diagnosis is the first critical step in the management of lung cancer. Our study aims at evaluating the process of pathological workup of lung cancer in the Middle East (ME).

Methods:Data of consecutive patients with non-small cell lung cancer were collected from centers in different countries in the ME. Methods of obtaining tissue and workup were analyzed.

Results:566 patients were recruited from 10 centers in 5 countries. The majority of patients were males (78.1%) with a median age of 61 years (22 – 89). 

The success in first attempt was as follows; Image guided core biopsy (91%), surgical biopsy (88%), endobronchial biopsy (79%) and cytology (30%). The success in the second attempt was as follows; surgical biopsy (100%), image guided core biopsy (95%), endobronchial biopsy (65%), cytology (55%). 19.7% (0 – 23%) of patients required two attempts and 5.2% (0 – 14%) required three or more attempts.

In a univariant analysis, stage IV was a predictor of increasing number of attempts (27.1% vs. 13.0% in stage I to III, p=0.003). The mean length of biopsy is significantly higher for frequent attempts than the first attempt (2.8 cm vs 2.2 cm, P-value=.001).

Conclusion: One out of five patients requires repeated biopsy in the ME with variation among centers. Image guided biopsy has the highest initial yield. Implementing clear process and multidisciplinary guidelines about the selection of diagnostic procedures is needed.