Mediastinal Staging of Lung Cancer

Lung cancer is the second most frequent neoplasm worldwide, and involvement of mediastinal nodal stations is a decisive prognostic element for therapeutic approach. Regarding preoperative imaging, computed tomography and fluorine-18-fludoglucose positron emission tomography are routinely recommended by various guidelines. However, sometimes both may not be able to detect lymph node metastatic pathology. Invasive methods are used for preoperative mediastinal nodal staging endoscopic, such as ultrasound-guided transbronchial needle aspiration, and surgical, such as mediastinoscopy and videothoracoscopy. Nowadays, endobronchial ultrasound needle aspiration is deemed the method of the first line to assess the staging of mediastinal involvement in lung neoplasm due to its safety and high sensitivity. Surgical techniques are considered if the endoscopic procedure is negative in patients with high suspected malignancy, or to detect lymph nodes not reachable by endoscopic probes. If re-staging is needed after therapy, invasive endoscopic or surgical techniques should be used, as neither CT nor PET scans alone are precise sufficiently to make definitive treatment solutions.