Mediastinal staging 2005: pictures, scopes, and scalpels.
Staging of the mediastinum for lung cancer has matured dramatically with the advent of newer technologies in imaging and endoscopic surveillance. Some of these technologies such as positron emission tomography (PET) scanning are becoming mainstream in the evaluation of patients with clinically suspicious mediastinal disease as seen on computed tomography (CT), while others such as endobronchial ultrasound are reserved for specialty expertise and await validation. While much improvement has been made in the accurate preoperative staging of patients having surgery as the primary modality in lung cancer, controversy exists regarding the restaging of locally advanced cases after induction chemotherapy or chemoradiotherapy. A major concentration on these restaging issues is warranted since it is now generally agreed that sterilization of the mediastinum after induction therapy has an impact on the prognosis of patients with stage IIIA disease, and accurate staging after therapy may rationally guide diverse therapeutic interventions in these patients.
Thoracic Oncology Section, Multidisciplinary Lung Team, Karmanos Cancer Institute, Detroit, MI, USA. hpass@dmc.org
Harvey I
HI
Pass
D001707:Biopsy, Needle; D001999:Bronchoscopy; D019160:Endosonography; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008479:Mediastinal Neoplasms / Q000175:diagnosis* / Q000556:secondary*; D008481:Mediastinoscopy; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging / Q000379:methods*; D049268:Positron-Emission Tomography; D021701:Sentinel Lymph Node Biopsy; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed