Invasive techniques in diagnosis and staging of lung cancer

Aim-Background During the staging process of lung cancer, accurate mediastinal lymph node staging is one of the more important factors to affect patient outcome. Accurate staging of the disease is important not only in determining prognosis but also in deciding the optimal treatment plan. The most significant treatment decision is establishing which patients can benefit from surgical resection and which should receive chemotherapy, radiation, or both. This paper reviews indications and current data regarding minimally invasive approaches for diagnosis and staging of lung cancer. In addition, current advances in diagnostic endoscopy for lung cancer will be reviewed. Methods A systematic literature search was performed to identify relevant reports. Studies and articles were identified using online searches of the U.S. National Library of Medicine via www.pubmed.com . We limited our bibliographic search to include only articles from 2008 onward. Results The thoracoscopic approach is currently considered the gold standard for the evaluation and treatment of suspected or known pleural effusion and in the diagnosis of indeterminate pulmonary nodules. It also has a complementary role to cervical mediastinoscopy in the invasive staging of mediastinal lymph nodes. Its role continues to evolve with regard to the management of lung cancer. Conclusions Mediastinoscopy has remained the ‘gold standard’ in invasive staging tests of the mediastinum. The classic way of invasively assessing the aortopulmonary window is the Chamberlain procedure, also known as an anterior mediastinotomy.