Staging Non–Small Cell Lung Cancer

Abstract

In Brief During the staging process of non–small cell lung cancer (NSCLC), accurate mediastinal lymph node staging is a critical factor which affects patient outcome. Cervical mediastinoscopy has been considered the “Gold Standard” for mediastinal staging in NSCLC. Recently, there is an increasing interest in minimally invasive endoscopic mediastinal staging techniques. In particular, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) uses ultrasound technology built into a flexible bronchoscope for real-time ultrasound-guided sampling of mediastinal lymph nodes. EBUS-TBNA has access to all of the mediastinal lymph nodes accessible by mediastinoscopy as well as N1 nodes. Based on the current evidence, EBUS-TBNA represents a minimally invasive procedure as an alternative to mediastinoscopy for mediastinal staging of NSCLC with discrete N2 or N3 lymph node enlargement, provided negative results are confirmed by surgical staging. Until we have the final results of the controlled comparative study of EBUS-TBNA versus mediastinoscopy, it is uncertain whether EBUS-TBNA will completely replace mediastinoscopy. It will also be important to incorporate new minimally invasive endoscopic techniques in the algorithm of lung cancer staging. EBUS-TBNA may be considered for initial staging of NSCLC in patients with suspicious mediastinal lymph nodes on noninvasive staging, provided negative results are confirmed by surgical staging. This will allow mediastinoscopy to be reserved for restaging after induction treatment. EBUS-TBNA also has potential for providing molecular diagnosis. Endobronchial ultrasound-guided transbronchial needle aspiration is a new minimally invasive modality for mediastinal staging of lung cancer. This article reviews the recent development and results of endobronchial ultrasound-guided transbronchial needle aspiration for lymph node staging and compares it to the “gold standard” mediastinoscopy.