Staging of lung cancer: the role of noninvasive, minimally invasive and invasive techniques

Abstract

Accurate staging and restaging of primary tumour and mediastinal nodes in patients with lung cancer is of significant importance. For primary tumours, computed tomography (CT) scans of the chest are recommended. Positron emission tomography (PET) imaging should be used in patients with curative intent treatment to evaluate metastatic disease. Diagnosis of the primary tumour should be performed using bronchoscopy or CT-guided transthoracic needle aspiration. In patients with enlarged mediastinal nodes and no distant metastasis, invasive staging of the mediastinum is required. For suspicious N2 or N3 disease, endoscopic needle techniques, such as endobronchial ultrasound and transbronchial needle aspiration, oesophageal ultrasound and fine needle aspiration, or a combination of both, are preferred to any surgical staging technique. In cases of suspicious nodes and negative results using needle aspiration techniques, invasive surgical staging using mediastinoscopy or video-assisted thoracic surgery should be performed. In central tumours or N1 nodes, preoperative invasive staging is indicated.Restaging after induction therapy remains a controversial topic. Today, neither CT, PET nor PET/CT scans are accurate enough to make final further therapeutic decisions for mediastinal nodal involvement. An invasive technique providing cytohistological information is still recommended.

Survival After Surgical Resection for Lung Cancer in Patients With Chronic Obstructive Pulmonary Disease

“…In our opinion, the present results underscored the usefulness of FDG-PET/CT in all lung cancer patients eligible for surgical resection. This was also supported by the findings in our previous study analyzing data from our database [83]. The study emphasized FDG-PET/CT to aid precise diagnosis of mediastinal lymph nodes in the preoperative staging of lung cancer.…”

Solid part size is an important predictor of nodal metastasis in lung cancer with a subsolid tumor

“…Currently available guidelines recommend that preoperative pathologic mediastinal evaluation (e.g., EBUS) should be considered regarding tumor size, radiologic N status, and tumor centrality [ 14 , 15 ]. However, they do not suggest recommendations exclusively for subsolid tumors.…”

Indicators and Qualitative Assessment of Lung Cancer Management by Health Insurance Review and Assessment Service (HIRA) of Korea in 2015

“…(4) Pulmonary function tests (forced expiratory volume in 1 second [FEV 1 ], diffusion lung capacity for carbon monoxide) are helpful in assessing the risk associated with surgery or radical radiotherapy 7 8 9 . (5) Mediastinoscopy, endobronchial ultrasound, and mediastinal lymph node dissection should be performed prior to treatment for mediastinal staging if N2 stage is suspected because mediastinal stage has a significant effect on treatment decisions and prognosis 10 11 12 . (6) In NSCLC patients who are not candidate of curative therapy, EGFR mutation test should be performed because EGFR tyrosine kinase inhibitors improve response rates, time to progression, and overall survival compared with systemic chemotherapy in patients harboring activating EGFR mutation 13 14 .…”