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When is it considered inappropriate to omit pathological mediastinal lymph node staging for non-small cell lung cancer?

The NCCN guidelines call for pathological mediastinal lymph node staging for all NSCLC except in solid tumors <1cm and non-solid lesions < 3cm. In my current institution, the patients almost never receive mediastinal staging and the patients are staged based on PET alone. In what situations should I really push for mediastinoscopy (EBUS is not available)?
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When, if ever, do you omit pathologic lymph node staging for early stage NSCLC with no evidence of nodal disease on PET/CT?

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3 Answers
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Radiation Oncology · City of Hope
Answered on

This is a very good question often debated by thoracic radiation oncologists with their thoracic surgery colleagues and can get complicated. The best way to look at it, in my opinion, is to understand the sensitivity and specificity of FDG PET/CT to detect true mediastinal nodal disease. For example...

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Radiation Oncology · University of Wisconsin Hospital & Clinics
Answered on

Here are some published guidelines for when to perform invasive mediastinal staging:

http://www.ncbi.nlm.nih.gov/pubmed/17873169

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3224039

Pathological mediastinal staging can be omitted in peripheral clinical stage 1A NSCLCs that have no enlarged or PET-avid l...

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Radiation Oncology · UCLA | VA Greater Los Angeles Healthcare System
Answered on

I once believed there was only one type of EBM. I now am certain there are two: Evidence-Based and Eminence-Based Medicine. These strategies are often at odds, can be reflected in guidelines, and typically emerge when our diagnostic and staging tools are far from accurate

Knowing a patient has N2 dis...

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