Chest
Invasive Staging of Non-small Cell Lung Cancer*: A Review of the Current Evidence
Section snippets
Materials and Methods
To evaluate the usefulness of TBNA, TTNA, EUS-NA, mediastinoscopy, and mediastinotomy in determining the presence or absence of metastatic disease in mediastinal lymph nodes, we analyzed published studies that reported the ability of the various invasive methods to correctly establish the pathologic stage of newly diagnosed or suspected lung cancer. In this review, needle aspiration is considered a type of biopsy. The terms needle aspiration and needle biopsy are, thus, considered
Results
As described above, data were abstracted and analyzed three ways. However, the results obtained by all three methods were essentially the same; therefore, we present results for scenario two, which assesses the ability of an invasive procedure to adequately stage patients with suspected lung cancer (either NSCLC or SCLC). In this scenario, patients enrolled in the study but suspected of having a diagnosis other than lung cancer were not considered evaluable and were excluded, where possible.
Discussion
Clinical staging is based on all information obtained about the primary tumor, its draining lymph node basins, and potential distant sites of metastasis prior to treatment initiation. Accurate clinical staging is paramount not only for estimating a patient's life expectancy and 5-year survival probability, but also because it directly impacts on the selection of appropriate therapy.
Clinical staging has been shown to differ markedly from pathologic staging at the time of resection. In a large
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Supported by a contract from the American College of Chest Physicians.