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World J Respirol. Jul 28, 2015; 5(2): 166-175
Published online Jul 28, 2015. doi: 10.5320/wjr.v5.i2.166
Current methods of staging and restaging of the mediastinal nodes in non-small-cell lung cancer
Marcin Zielinski
Marcin Zielinski, Department of Thoracic Surgery, Pulmonary Hospital, 34500 Zakopane, Poland
Author contributions: Zielinski M designed, performed research, analyzed data and wroted the paper.
Conflict-of-interest statement: The author declares no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Marcin Zielinski, MD, PhD, Department of Thoracic Surgery, Pulmonary Hospital, Ul. Gładkie 1, 34500 Zakopane, Poland. marcinz@mp.pl
Telephone: +48-18-2015045 Fax: +48-18-2014632
Received: November 24, 2014
Peer-review started: November 26, 2014
First decision: January 20, 2015
Revised: April 13, 2015
Accepted: July 7, 2015
Article in press: July 8, 2015
Published online: July 28, 2015
Abstract

To analyze the current methods of primary staging and repeated staging (restaging) of the mediastinal nodes in non-small-cell lung cancer (NSCLC), all methods currently used for staging of NSCLC are analyzed. These methods include imaging techniques [computer tomography (CT), positron emission tomography (PET) combined with CT (PET/CT)], endoscopic/ultrasound techniques (endobronchial ultrasound/transbronchial needle aspiration) and endoscopic ultrasound/fine needle aspiration and surgical techniques [standard cervical mediastinoscopy, video-assisted mediastinoscopy, extended mediastinoscopy, video-assisted mediastinoscopic lymphadenectomy, transcervical extended mediastinal lymphadenectomy, anterior mediastinotomy (Chamberlain procedure) and video-assisted thoracic surgery]. The diagnostic yield of Chest CT is regarded insufficient for both, primary staging and restaging. The PET/CT became a standard imaging technique preceding curative surgery of radical chemo-radiotherapy. The issue of intraoperative staging is also described. Finally, the author’s proposed algorithm of staging, both for primary staging and restaging after neoadjuvant therapy is presented. Detailed staging of NSCLC enables selection of patients with early stage disease for curative surgical/multimodality treatment and helps to avoid unnecessary surgery in advanced disease.

Keywords: Lung cancer, Staging, Endoscopy, Surgery, Mediastinum

Core tip: All methods currently used for staging of non-small-cell lung cancer are analyzed. These methods include imaging techniques [computer tomography (CT), positron emission tomography (PET) combined with CT (PET/CT)], endoscopic/ultrasound techniques endobronchial ultrasound/transbronchial needle aspiration and endoscopic ultrasound/fine needle aspiration and surgical techniques standard cervical mediastinoscopy, video-assisted mediastinoscopy, extended mediastinoscopy, video-assisted mediastinoscopic lymphadenectomy, transcervical extended mediastinal lymphadenectomy, anterior mediastinotomy (chamberlain procedure) and video-assisted thoracic surgery. The issue of intraoperative staging is also described. Finally, the author’s proposed algorithm of staging, both for primary staging and restaging after neoadjuvant therapy is presented.