Mediastinal Staging in Lung Cancer

Correspondence: Vasileios S. Skouras, MD, PhD Department of Pulmonary and Sleep Medicine 401 General Army Hospital 1 Kanellopoulou Street, 11526, Athens, Greece Tel.: +306973380282, Fax: +302106997765 Ε-mail: [email protected] SUMMARY. Lung cancer is the most lethal cancer worldwide. The most favourable prognosis is achieved with complete resection of the malignant tumour, which is only feasible in the absence of both distant metastases and mediastinal involvement. The suitability for surgery in patients without metastases is therefore determined by accurate mediastinal staging. The methods available for this purpose include imaging and invasive techniques, but as no single method is sufficiently accurate at ruling in and ruling out mediastinal involvement in lung cancer a strategy based on the sequential use of staging methods is required. The cost-effectiveness of such a strategy depends on the sequence of the methods chosen and the requirement for further confirmation of the results of each method. The management of positive results derived from the various staging methods is well documented, but not the management of negative results, for which the current literature is not conclusive. The estimation by probability analysis of negative post-test probabilities following the use of the various methods can assist in the management of negative results and also provides guidance for future research related to the design of the most cost-effective strategy for staging mediastinal involvement in lung cancer. Pneumon 2014, 27(1):16-31.