Pulmonologists have contributed significantly to the detection, diagnosis, and management of lung cancer in the past two decades. Improved understanding of lung cancer epidemiology and risk factors has informed screening programs across the world. Refinements in bronchoscopy have allowed the development of minimally invasive techniques for diagnosis and staging of lung cancer. Technological advances in endoluminal treatments for lung cancer coupled with refinements in navigational bronchoscopy raise the possibility of a one-step diagnosis-staging-treatment for early stage lung cancer. Advances in evaluation and management of malignant pleural effusions have led to better clinical outcomes and quality of life. Better understanding of lung cancer pathogenesis has identified biomarkers that inform cancer risk stratification, application of targeted therapies, treatment-related side effects, and likelihood of recurrence. The growing subspecialization of lung cancer care, coupled with rapid technological and clinical developments, has made essential the multidisciplinary team approach for delivering high-quality, evidence-based care. In this article, an international panel of experts will review the major developments in pulmonary diagnostics in lung cancer in the past two decades. Together, these developments have had a transformative effect on lung cancer care and clinical outcomes. The clinical impact of these developments will be explored, along with future potential for research and innovation, and presented in two parts, first for essential standards and second for emerging innovations.