Optimiser le bilan d'extension locorégional

Abstract

The initial assessment must meet four goals: assessing the clinical status, obtain a histological proof of diagnosis, set the stage cTNM, and if resectability, define whether the patient is operable. The locoregional staging modalities are based on national and international guidelines. Physical examination should be performed. Thorax CT-scan with contrast should be performed in all patients, except contraindication. CT can determine tumor size, bronchus, pleural, mediastinal and vascular invasion. The sensitivity and specificity of CT scan for identifying mediastinal lymph node metastasis is 61% and 79%, respectively. PET-CT is not indicated systematically but only for patients considered for curative intent treatment. The sensitivity and specificity of PET-CT for identifying mediastinal lymph node metastasis is 80 % and 80-90%, respectively. For patients with extensive mediastinal infiltration, CT assessment is sufficient. In patients with discrete mediastinal lymph node enlargement or PET uptake in mediastinal nodes or a centrally located tumour or a tumour > 3cm or N1 node, an invasive staging of the mediastinum is indicated. A needle technique (EBUS-TBNA or EUS-FNA or combined EBUS/EUS) is recommended over surgical staging. Stage IIIAN2 should be classified into potentially resectable N2, potentially resectable N2 but risk of incomplete resection and unresectable N2. The adherence to guidelines and organizational factors improve the management.