The non‐invasive mediastinal staging of non‐small lung cancer

Four years after the 1st edition [1], the American College of Chest Physicians (ACCP) has published its 2nd edition of their evidence based clinical practice guidelines on the di‐ agnosis and management of lung cancer [2]. The goal of these guidelines is to assist chest physicians in achieving the best outcomes possible for their patients taking into account the new evidence based knowledge and techniques available. The ACCP guidelines incorporate all evidence recent‐ ly published about lung cancer diagnosis and treatment, and represent the most comprehensive summary currently avail‐ able. The document is over 400 pages and provides the read‐ er also with systematic summaries of the recommendations in each chapter. The authors of these guidelines have to be commended for this truly herculean task, which will set the stage for the approach to the patient with (presumed) lung cancer in the next years. Compared to the previous 2003 edition [1], a number of changes have occurred. It would be helpful for the read‐ er with some background in the matter to include an over‐ view of those changes that were implemented since, in order to quickly get informed of the novel evidence. Not unexpect‐ edly, the emphasis is largely put on US evidence and approach as this is the main target audience of the journal. However, compared to the previous issue, more non‐US and specifical‐ ly European authors were involved, making the guidelines breathe a more worldwide view than before. The editors have to be credited for this approach. In this editorial, we will only address the issues of medi‐ astinal staging and approach of stage IIIA non‐small cell lung cancer (NSCLC) and will not comment on other topics which are also discussed thoroughly in the new ACCP guidelines [2]. The large amount of new evidence, especially on invasive me‐