Optimizing Systematic Endoscopic Lymph Node Staging in Non-Small Cell Lung Cancer: Proposals for Integrating the 9th
Daniel P Steinfort1,2, Matthew Evison3,4
1Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, 300 Grattan Street, Melbourne, VIC 3050, Australia.
Abstract:
Systematic endoscopic mediastinal lymph node staging is imperative to most accurately define the extent of LN involvement in patients with locally advanced (cN2) NSCLC. It provides the most accurate nodal information in comparison to imaging techniques and is the most likely investigation to differentiate N2a from N2b disease. Accumulation of evidence to validate the prognostic, and potentially the predictive value of accurately defining N2a and N2b N-status will be supported by more consistent and more comprehensive mediastinal endoscopic staging in this group, aided by more detailed (synoptic) reporting. We identify proposed solutions for enhancement of systematic staging in patients with N2 NSCLC, including routine performance of systematic lymph node assessment, with sampling of all LN > 6 mm, addition of EUS-B-FNA where possible, and use of synoptic reporting to reduce variance in care and enable performance monitoring.
