Mediastinal re‐staging of non small‐cell lung cancer

Selected patients with non small‐cell lung cancer (NSCLC) with mediastinal lymph node involvement may have a survival benefit from surgical resection, particularly if mediastinal nodal down‐staging occurs after induction therapy and complete resection is achieved with lobectomy. Accurate re‐staging of the mediastinum after induction therapy is therefore crucial in determining prognosis and subsequent treatment. Non‐invasive imaging techniques usually require a confirmatory tissue sampling method to improve the accuracy of mediastinal re‐staging. As in the initial staging of the mediastinum, minimally invasive endosonography‐guided needle sampling techniques such as endobronchial ultrasound‐guided fine‐needle aspiration (EBUS‐TBNA) and endoscopic ultrasound‐guided fine‐needle aspiration show promise in re‐staging the mediastinum, though invasive surgical re‐staging remains the gold standard. Despite a lower sensitivity in the mediastinal re‐staging of NSCLC, EBUS‐TBNA with or without EUS‐FNA may still be the preferred initial mediastinal re‐staging technique.