[Endoscopic and invasive approach]

Bronchoscopy plays a major role in the histological diagnosis of stage III lung cancer and the choice among bronchoscopic techniques may very according to the central or peripheral localization of the lesion. To obtain the histological diagnosis, percutaneous needle aspiration and bronchoscopic procedures are rather complementary. In staging of bronchogenic carcinoma, bronchoscopy may confirm neoplastic involvement of the main carina (T4), involvement within 2 cm of the main carina (T3) or involvement of mediastinal nodes (N2 or N3) by the use of transbronchial needle aspiration. Extension of lung cancer to intrathoracic lymph nodes is better assessed by mediastinoscopy. The use of thoracoscopy in staging has been increasing in particular in cases of concomitant pleural effusion.