Optimal initial pathologic mediastinal staging of lung cancer: EUS, EBUS, mediastinoscopy

Patients with suspected lung cancer require tissue diagnosis and accurate staging to determine optimal treatment. In the absence of distant metastases, mediastinal lymph node staging is an important branch point in deciding therapy. The initial clinical evaluation of patients with suspected lung cancer includes a contrast CT scan of the chest and upper abdomen that provides staging information about the T descriptor and usually leads to a presumptive clinical staging of the mediastinal lymph nodes. Increasingly, this clinical CT assessment is being supplemented or replaced altogether in routine clinical practice with a CT-PET scan. The CT portion of the CT-PET examination is performed without intravenous contrast and is of lower resolution than a dedicated CT scan. One often comes across the caveat describing the CT as not of diagnostic quality in the radiologic reports. For the purpose of this discussion, we will assume that the patient has known or suspected lung cancer and has undergone a CT scan and CT-PET examination.