Methods for Staging Non-small Cell Lung Cancer

CT scanning of the chest is useful in providing anatomic detail that better identifies the location of the tumor and its proximity to local structures and determines whether lymph nodes in the mediastinum are enlarged. Unfortunately, the accuracy of chest CT scans in differentiating benign from malignant lymph nodes in the mediastinum is unacceptably low. PET scanning provides functional information of tissue activity and has much better sensitivity and specificity than chest CT scanning for staging lung cancer in the mediastinum. In addition, distant metastatic disease can be detected by PET scans, and noncurative resections can be averted. Still, positive findings on PET scans can occur from nonmalignant causes (eg, infections), so tissue sampling to confirm suspected metastasis is almost always required to ensure that potential surgical candidates are not misclassified as having advanced disease. Confirmation of mediastinal nodal status can be performed using a myriad of invasive tools. Although this guideline recommends the use of minimally invasive guided needle techniques as the test of first choice, the location of the lymph node, patient comorbidities, and local availability of and expertise with the different invasive staging tools will continue to drive which tool is used in which patient. It is far more important to obtain a tissue sample of the mediastinal node or nodes in question than to quibble over which invasive staging tool was used to get there.