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CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2021; 42(05): 406-414
DOI: 10.1055/s-0041-1739345
Review Article

Controversies in Mediastinal Staging for Nonsmall Cell Lung Cancer

Authors

  • Apurva Ashok

    1   Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India

  • Sabita S. Jiwnani

    1   Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India

  • George Karimundackal

    1   Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India

  • Maheema Bhaskar

    2   Department of Pulmonology, Tata Memorial Hospital, Mumbai, Maharashtra, India

  • Nitin S. Shetty

    3   Division of Interventional Radiology, Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India

  • Virendra Kumar Tiwari

    1   Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India

  • Devayani M. Niyogi

    1   Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India

  • C. S. Pramesh

    1   Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Abstract

Mediastinal lymph nodal involvement in nonsmall cell lung cancer plays a crucial role in deciding treatment strategy. Survival falls markedly with increasing involvement of mediastinal nodal stations. Hence, accurate staging of the mediastinum with lowest morbidity is of utmost importance. A wide array of invasive and noninvasive modalities that complement each other in assessing the nodes are available at our disposal. Guidelines recommend noninvasive imaging as the initial step in the staging algorithm for all tumors, followed by invasive staging. No single modality has proven to be the ideal method to stage the mediastinum when used alone. In the present decade, minimally invasive endobronchial ultrasound (EBUS) has challenged the position of surgical mediastinoscopy, which has been the gold standard, historically. However, a negative EBUS needs to be confirmed by surgical mediastinoscopy. Video-assisted mediastinoscopic lymphadenectomy has also come to the forefront in last two decades and has shown exceptional results, when performed in experienced centers. This review details the various modalities of mediastinal staging and the controversies surrounding the optimal method of staging, restaging after neoadjuvant therapy, and the most cost-effective strategy.

Keywords

mediastinal staging - endobronchial ultrasound - mediastinoscopy - VAMLA - nonsmall cell lung cancer


Publication History

Article published online:
24 December 2021

© 2021. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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