For small peripherally located NSCLC, when do consider referral for mediastinal evaluation prior to curative surgery vs proceeding to resection with mediastinal eval at time of surgery?

Although there is variability among the different guidelines (ACCP, ESTS, NCCN) in regards to mediastinal staging, there is consensus that no invasive staging is required for peripheral nodules which are T1A (T1abcN0) given the low prevalence of occult N2 disease. Invasive mediastinal staging should be considered for early stage tumors when they are centrally located (the definition of centrally located tumor is also an area of debate, but is typically considered lesions within the inner 1/3 of ...

There are slight differences in the recommendations for invasive mediastinal staging made by the American College of Chest Physicians, European Society of Thoracic Surgeons and the Cancer Care Ontario guidelines. In summary patients with large tumors, central tumors, suspected N1 or N2/N3 disease on CT or PET need mediastinal evaluation. The European Society of Thoracic Surgeons also suggests mediastinal staging for patients with low PET uptake in the prior tumor, given the concern that occult m...