A practical framework of preoperative imaging for non-small cell lung cancer: Thoracic surgeons’ expectations from radiologists

Accurate preoperative imaging is essential for determining operability, guiding surgical planning, and optimizing outcomes in the treatment of non-small cell lung cancer (NSCLC). This paper outlines thoracic surgeons' expectations from radiologists in the preoperative evaluation of NSCLC, aiming to enhance multidisciplinary collaboration and improve radiologic reporting standards. A narrative review of imaging modalities-including CT, PET-CT, and MRI-was conducted to identify key radiologic parameters relevant to surgical decision-making. The paper integrates current Tumor, nodes, metastasis (TNM) staging criteria, tumor morphology, anatomical localization, and invasion patterns, with practical surgical implications. Radiologists are expected to provide precise measurements of tumor size and morphology, assess nodal involvement and metastatic spread, and identify critical anatomical relationships and variations. Imaging should detail tumor invasion into adjacent structures such as the chest wall, mediastinum, and vascular or airway components. The paper also emphasizes the importance of imaging in evaluating suitability for minimally invasive surgery, guiding lesion localization, and assessing underlying lung pathology and post-induction therapy response. A standardized, surgeon-oriented imaging report enhances surgical planning, reduces intraoperative risks, and supports personalized treatment strategies. This paper serves as a practical guide for radiologists to align imaging assessments with thoracic surgical needs, ultimately improving patient outcomes.