Mediastinal Staging of Non-Small-Cell Lung Cancer

Christian Lloyd, MD, and Gerard A. Silvestri, MD, FCCP, Division of Pulmonary and Critical Care Medicine at the Medical University of South Carolina, Charleston.

Cancer Control. 2001;8(4) 

In This Article


We have presented a brief look at the present state of mediastinal staging including PET imaging, FUS, and TBNA. Fig 2 is a potential algorithm for staging the mediastinum nonsurgically.

Figure 2.

Potential algorithm for nonsurgical mediastinal staging of NSCLC based on size and location of lymph nodes.

It appears the strength of PET imaging may lie in its strong negative predictive value. TBNA offers the advantage of being able to potentially stage the patient at the time of diagnosis. Sensitivity remains somewhat low, with the best results from right paratracheal or subcarinal lymph nodes. EUS offers the advantage of being able to sample lymph nodes smaller than 1 cm and can sample stations not easily accessible by TBNA or mediastinoscopy. These include paraesophageal and aortopulmonary lymphatics. In conclusion, the patient should never be denied potentially curative resection without tissue confirmation of malignant spread. These new modalities will undoubtedly improve the pretreatment staging of NSCLC.


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