Indications for invasive mediastinal staging for non-small cell lung cancer

Accurate mediastinal staging remains a key component in the workup of patients with lung cancer, since treatment options and prognosis vary depending on the stage. While imaging studies continue to evolve, invasive mediastinal staging plays an important role in confirming nodal disease and ruling out false positives such as granulomatous lymph nodes. Thoracic surgeons must understand the advantages and disadvantages of each approach to mediastinal staging, the sensitivity and negative predictive value of different techniques, and the role of invasive mediastinal staging in the clinical decision making for different stages of lung cancer. While (EBUS-TBNA) has assumed a more prominent role over mediastinoscopy, it is important for surgeons to be facile with these techniques, the correct indications for their use, and when to proceed with mediastinoscopy despite a negative EBUS-TBNA if there continues to be high suspicion for mediastinal nodal disease. It is important that patients undergo appropriate mediastinal staging when indicated even when the planned treatment approach is stereotactic radiation or wedge resection because of poor pulmonary function or comorbidities, since the identification of stage III disease could alter the treatment approach.