摘要
To analyze the current methods of primary staging and repeated staging(restaging) of the mediastinal nodes in non-small-cell lung cancer(NSCLC), all methods currently used for staging of NSCLC are analyzed. These methods include imaging techniques [computer tomography(CT), positron emission tomography(PET) combined with CT(PET/CT)], endoscopic/ultrasound techniques(endobronchial ultrasound/transbronchial needle aspiration) and endoscopic ultrasound/fine needle aspiration and surgical techniques [standard cervical mediastinoscopy, video-assisted mediastinoscopy, extended mediastinoscopy, videoassisted mediastinoscopic lymphadenectomy, transcervical extended mediastinal lymphadenectomy, anterior mediastinotomy(Chamberlain procedure) and videoassisted thoracic surgery]. The diagnostic yield of Chest CT is regarded insufficient for both, primary staging and restaging. The PET/CT became a standard imaging technique preceding curative surgery of radical chemoradiotherapy. The issue of intraoperative staging is also described. Finally, the author's proposed algorithm of staging, both for primary staging and restaging after neoadjuvant therapy is presented. Detailed staging of NSCLC enables selection of patients with early stage disease for curative surgical/multimodality treatment and helps to avoid unnecessary surgery in advanced disease.
To analyze the current methods of primary staging and repeated staging(restaging) of the mediastinal nodes in non-small-cell lung cancer(NSCLC), all methods currently used for staging of NSCLC are analyzed. These methods include imaging techniques [computer tomography(CT), positron emission tomography(PET) combined with CT(PET/CT)], endoscopic/ultrasound techniques(endobronchial ultrasound/transbronchial needle aspiration) and endoscopic ultrasound/fine needle aspiration and surgical techniques [standard cervical mediastinoscopy, video-assisted mediastinoscopy, extended mediastinoscopy, videoassisted mediastinoscopic lymphadenectomy, transcervical extended mediastinal lymphadenectomy, anterior mediastinotomy(Chamberlain procedure) and videoassisted thoracic surgery]. The diagnostic yield of Chest CT is regarded insufficient for both, primary staging and restaging. The PET/CT became a standard imaging technique preceding curative surgery of radical chemoradiotherapy. The issue of intraoperative staging is also described. Finally, the author's proposed algorithm of staging, both for primary staging and restaging after neoadjuvant therapy is presented. Detailed staging of NSCLC enables selection of patients with early stage disease for curative surgical/multimodality treatment and helps to avoid unnecessary surgery in advanced disease.
