Preoperative staging of the mediastinum is an essential and multidisciplinary task

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 evidencebased 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.

Occult lymph node metastases in clinical N0/N1 NSCLC; A single center in-depth analysis

“…In our routine EBUS staging procedures, all lymph nodes >5 mm short axis are aspirated [33,34]. Our MDT consists out of oncological pulmonologists, thoracic radiologists, pathologists, radiation oncologists and cardiothoracic surgeons, organized in a multidisciplinary team dedicated to lung cancer care [35].…”

The Value of a Systematic Protocol Using Endobronchial Ultrasound and Endoscopic Ultrasound in Staging of Lung Cancer for Patients with Imaging iN0–N1 Disease

“…Accurate staging is essential in lung cancer management. Both the treatment and prognosis depend not only on its histological type but also on the stage of the disease [1][2][3].…”

Essential update in lung cancer medicine

“…Of course, accurate staging is crucial if we are to allocate appropriate treatment and avoid futile invasive therapies. Sanz‐Santos and Call 6 argue that the multidisciplinary team is at the core of good staging and provide a stepwise approach to complete mediastinal staging. Having presented the current literature, they go on to pose a number of key questions that serve as a roadmap to further research.…”