Case studies in the diagnosis and staging of non-small cell lung cancer

Lung cancer is the most common cause of cancer death in men and women. While overall survival rates remain dismal, survival for early stage disease approaches 70%. Expedient, accurate staging is vital to ensure timely resection of all potentially curable disease. Conversely, accurate staging is important in preventing unnecessary surgery. While a negative clinical evaluation has a high negative predictive value, many clinicians routinely order conventional imaging to exclude distant metastases. In this article, five case vignettes are presented to demonstrate the international system for staging lung cancer, including the most recent modifications. Various tumor characteristics and patterns of lymph node involvement are explored to demonstrate the subtleties of staging. The accuracy of various diagnostic modalities in the evaluation for mediastinal and distant metastasis is discussed.