Invasive Mediastinal Staging of Non-small Cell Lung Cancer

Patient Population

NSCLC patients in Ontario who have been clinically staged T1-4, N0-3, with no distant metastases.

Intended Guideline Users

Thoracic surgeons, respirologists, and medical as well as radiation oncologists who treat lung cancer.

Research Question(s)

Primary Questions:

1. Is invasive mediastinal staging in stage cT1-4, N0-3, M0 non-small cell lung cancer (NSCLC) patients indicated under the following circumstances?
   
   1. Normal-sized mediastinal lymph nodes on computed tomography scan (CT), and
      
      1. negative positron emission tomography (PET)-CT scan in the mediastinum
      2. positive PET-CT in the mediastinum
   2. Enlarged discrete mediastinal nodes on CT (clinical N2 or N3 nodes), and
      
      1. negative PET-CT in the mediastinum
      2. positive PET-CT in the mediastinum

Secondary Questions:

1. What constitutes invasive mediastinal staging?
2. What is the proper technique in performing invasive mediastinal staging?
   
   1. Which node stations should be biopsied?
   2. How many lymph nodes should be biopsied?