Lung cancer staging: a concise update

Abstract

Diagnosis and clinical staging of lung cancer are fundamental to planning therapy. The techniques for clinical staging, anatomic and metabolic imaging, endoscopies and minimally invasive surgical procedures, should be performed sequentially and with an increasing degree of invasiveness. Intraoperative staging, assessing the magnitude of the primary tumour, the involved structures, and the loco-regional lymphatic spread by means of systematic nodal dissection, is essential in order to achieve a complete resection. In resected tumours, pathological staging, with the systematic study of the resected specimens, is the strongest prognostic indicator and is essential to make further decisions on therapy. In the present decade, the guidelines on lung cancer staging of the American College of Chest Physicians and the European Society of Thoracic Surgeons are based on the best available evidence and are widely followed. Recent advances in the classification of the adenocarcinoma of the lung, with the definition of adenocarcinoma , minimally invasive adenocarcinoma and lepidic predominant adenocarcinoma, and the publication of the eighth edition of the tumour, node and metastasis classification of lung cancer, have to be integrated into the staging process. The present review complements the latest guidelines on lung cancer staging by providing an update of all these issues.

Prognostic value of site-specific metastases in lung cancer: A population based study

“…Oftentimes, lung cancer will spread to more than one area of the body. Due to the differences in biological heterogeneity and treatment strategies, the survival of patients with various metastatic sites is variable13, 14. Therefore, knowledge of the patterns of distant metastasis is crucial to personalize the treatment and follow-up strategies.…”

Video-Assisted Mediastinoscopic Lymphadenectomy (VAMLA): Recipe and Cooking Secrets (a Tutorial)

“…We have to bring 2 aspects to mind: (1) the ancient but still present definition of an N3-status meaning surgically not accessible and (2) it is becoming increasingly clear that the percentage of positive lymph nodes (the so called "node ratio") depict the clinically relevant tumor stadium more accurate than the anatomical N2/3 categorization. [14][15][16][17][18][19][20] Both keynotes will be translated into the upcoming 9th edition of the Union for International Cancer Control staging system for lung cancer-as well as being basis for ongoing research as clinical investigators increasingly lift out the lively character of a tumor instead of its strict compartmentation. So after more than 60 years of great facility and constant advancements the golden age of up-to-date mediastinoscopy-which is called VAMLA for nearly 20 years-is not over for a long time yet.…”

Mediastinal staging by videomediastinoscopy in clinical N1 non-small cell lung cancer

“…In a recent paper on lung cancer staging in the European Respiratory Journal , R ami- P orta et al . [ 10 ] suggest that in early-stage, operable NSCLC, EBUS-TBNA should not be of routine use and that mediastinoscopy may be the preferred method to preoperative mediastinal staging.…”

“…Previous guidelines published by European Society of Gastrointestinal Endoscopy in cooperation with the European Respiratory Society and the European Society of Thoracic Surgeons recommend that endosonography should be performed over surgical staging as the initial procedure for mediastinal nodal staging in patients with suspected or proven NSCLC and abnormal mediastinal and/or hilar nodes at computed tomography (CT) and/or fluorodeoxyglucose (FDG) positron emission tomography (PET)-CT, (recommendation grade A) [ 4 ]. However, recent studies report relatively low sensitivity for endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) to detect mediastinal disease in clinical N0 PET-CT, while others report a significant risk of mediastinal nodal involvement in patients classified as clinical N1 by PET-CT [ 5 – 10 ].…”