Invasive mediastinal staging of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition)

Frank C. Detterbeck, Michael A. Jantz, Michael Wallace, Johan Vansteenkiste, Gerard A. Silvestri

Research output: Contribution to journalArticlepeer-review

562 Scopus citations


Background: The treatment of non-small cell lung cancer (NSCLC) is determined by accurate definition of the stage. If there are no distant metastases, the status of the mediastinal lymph nodes is critical. Although imaging studies can provide some guidance, in many situations invasive staging is necessary. Many different complementary techniques are available. Methods: The current guidelines and medical literature that are applicable to this issue were identified by computerized search and were evaluated using standardized methods. Recommendations were framed using the approach described by the Health and Science Policy Committee of the American College of Chest Physicians. Results: Performance characteristics of invasive staging interventions are defined. However, a direct comparison of these results is not warranted because the patients selected for these procedures have been different. It is crucial to define patient groups, and to define the need for an invasive test and selection of the best test based on this. Conclusions: In patients with extensive mediastinal infiltration, invasive staging is not needed. In patients with discrete node enlargement, staging by CT or positron emission tomography (PET) scanning is not sufficiently accurate. The sensitivity of various techniques is similar in this setting, although the false-negative (FN) rate of needle techniques is higher than that for mediastinoscopy. In patients with a stage II or a central tumor, invasive staging of the mediastinal nodes is necessary. Mediastinoscopy is generally preferable because of the higher FN rates of needle techniques in the setting of normal-sized lymph nodes. Patients with a peripheral clinical stage I NSCLC do not usually need invasive confirmation of mediastinal nodes unless a PET scan finding is positive in the nodes. The staging of patients with left upper lobe tumors should include an assessment of the aortopulmonary window lymph nodes.

Original languageEnglish (US)
Pages (from-to)202S-220S
Issue number3 SUPPL.
StatePublished - Sep 2007


  • Anterior mediastinotomy
  • Bronchoscopy
  • Chamberlain procedure
  • Clinical staging
  • Endobronchial ultrasound
  • Esophageal ultrasound
  • Mediastinal lymph nodes
  • Mediastinoscopy
  • N2
  • N3
  • Pathologic staging
  • Staging
  • Transbronchial needle aspiration

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine


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