Preoperative staging of the mediastinum is an essential and multidisciplinary task
Open Access
- 12 July 2020
- journal article
- review article
- Published by Wiley in Respirology
- Vol. 25 (S2), 37-48
- https://doi.org/10.1111/resp.13901
Abstract
Mediastinal staging is a crucial step in the management of patients with NSCLC. With the recent development of novel techniques, mediastinal staging has evolved from an activity of interest mainly for thoracic surgeons to a joint effort carried out by many specialists. In this regard, the debate of cases in MDT sessions is crucial for optimal management of patients. Current evidence‐based clinical guidelines for preoperative NSCLC staging recommend that mediastinal staging should be performed with increasing invasiveness. Image‐based techniques are the first approach, although they have limited accuracy and findings must be confirmed by pathology in almost all cases. In this setting, the advent of radiomics is promising. Invasive staging depends on procedural factors rather than diagnostic performance. The choice between endoscopy‐based or surgical procedures should depend on the local expertise of each centre. As the extension of mediastinal disease in terms of number of involved lymph nodes and nodal stations affects prognosis and the choice of treatment, systematic samplings are preferred over random targeted samplings. Following this approach, a diagnosis of single mediastinal nodal involvement can be unreliable if all reachable mediastinal nodal stations have not been assessed. The performance of confirmatory mediastinoscopy after a negative endoscopy‐based procedure is controversial but currently recommended. Current indications of invasive staging in patients with radiologically normal mediastinum have to be re‐evaluated, especially for central tumour location.This publication has 68 references indexed in Scilit:
- Video-assisted mediastinoscopic lymphadenectomy is associated with better survival than mediastinoscopy in patients with resected non–small cell lung cancerThe Journal of Thoracic and Cardiovascular Surgery, 2013
- Negative Predictive Value of Positron Emission Tomography and Computed Tomography for Stage T1-2N0 Non–Small-Cell Lung Cancer: A Meta-AnalysisClinical Lung Cancer, 2012
- False-negative rate after positron emission tomography/computer tomography scan for mediastinal staging in cI stage non-small-cell lung cancerEuropean Journal of Cardio-Thoracic Surgery, 2012
- Thoroughness of Mediastinal Staging in Stage IIIA Non-small Cell Lung CancerJournal of Thoracic Oncology, 2012
- Causes and Consequences of Deviation from Multidisciplinary Care in Thoracic OncologyJournal of Thoracic Oncology, 2011
- Which is the Better Prognostic Factor for Resected Non-small Cell Lung Cancer: The Number of Metastatic Lymph Nodes or the Currently Used Nodal Stage Classification?Journal of Thoracic Oncology, 2011
- Occult nodal metastasis in patients with non‐small cell lung cancer at clinical stage IA by PET/CTRespirology, 2010
- Enhancement of a multianalyte serum biomarker panel to identify lymph node metastases in non‐small cell lung cancer with circulating autoantibody biomarkersInternational Journal of Cancer, 2010
- Endobronchial ultrasound-guided transbronchial needle aspiration for staging of lung cancer: A systematic review and meta-analysisEuropean Journal of Cancer, 2009
- Lymph node staging by means of positron emission tomography is less accurate in non-small cell lung cancer patients with enlarged lymph nodes: Analysis of 1145 lymph nodesLung Cancer, 2008