Methods For Staging Non-Small Cell Lung Cancer: Diagnosis And Management Of Lung Cancer
Publication Date: May 1, 2013
Recommendations
General Approach to Patients
For patients with either a known or suspected lung cancer who are eligible for treatment, a CT scan of the chest with contrast is recommended. (1, B)
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For patients with either a known or suspected lung cancer, it is recommended that a thorough clinical evaluation be performed to provide an initial definition of tumor stage. (1, B)
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In patients with either a known or suspected lung cancer who have an abnormal clinical evaluation and no suspicious extrathoracic abnormalities on chest CT, additional imaging for metastases is recommended. (1, B)
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Extrathoracic Staging
In patients with a normal clinical evaluation and no suspicious extrathoracic abnormalities on chest CT being considered for curative-intent treatment, PET imaging (where available) is recommended to evaluate for metastases (except the brain). (1, B)
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In patients with an imaging finding (eg, by PET) suggestive of a metastasis, further evaluation of the abnormality with tissue sampling to pathologically confirm the clinical stage is recommended prior to choosing treatment. (1, B)
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In patients with clinical stage III or IV NSCLC it is suggested that routine imaging of the brain with head MRI (or CT if MRI is not available) should be performed, even if they have a negative clinical evaluation. (2, C)
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Staging of the Mediastinum
For patients with extensive mediastinal infi ltration of tumor and no distant metastases, it is suggested that radiographic (CT) assessment of the mediastinal stage is usually sufficient without invasive confirmation. (2, C)
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In patients with discrete mediastinal lymph node enlargement (and no distant metastases) with or without PET uptake in mediastinal nodes, invasive staging of the mediastinum is recommended over staging by imaging alone. (1, C)
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In patients with PET activity in a mediastinal lymph node and normal appearing nodes by CT (and no distant metastases), invasive staging of the mediastinum is recommended over staging by imaging alone. (1, C)
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In patients with high suspicion of N2,3 involvement, either by discrete mediastinal lymph node enlargement or PET uptake (and no distant metastases), a needle technique (EBUS-NA, EUS-NA or combined EBUS/EUS-NA) is recommended over surgical staging as a best first test. (1, B)
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In patients with an intermediate suspicion of N2,3 involvement, ie, a radiographically normal mediastinum (by CT and PET) and a central tumor or N1 lymph node enlargement (and no distant metastases), invasive staging of the mediastinum is recommended over staging by imaging alone. (1, C)
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In patients with an intermediate suspicion of N2,3 involvement, ie, a radiographically normal mediastinum (by CT and PET) and a central tumor or N1 lymph node enlargement (and no distant metastases), a needle technique (EBUS-NA, EUS-NA or combined EBUS/EUS-NA) is suggested over surgical staging as a best first test. (2, B)
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For patients with a peripheral clinical stage IA tumor (negative nodal involvement by CT and PET), it is suggested that invasive preoperative evaluation of the mediastinal nodes is not required. (2, B)
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For the patients with a LUL cancer in whom invasive mediastinal staging is indicated as defi ned by the previous recommendations, it is suggested that invasive assessment of the APW nodes be performed (via Chamberlain, VATS, or extended cervical mediastinoscopy) if other mediastinal node stations are found to be uninvolved. (2, B)
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Title
Methods For Staging Non-Small Cell Lung Cancer: Diagnosis And Management Of Lung Cancer
Authoring Organization
American College of Chest Physicians
Publication Month/Year
May 1, 2013
External Publication Status
Published
Country of Publication
US
Document Objectives
Correctly staging lung cancer is important because the treatment options and prognosis differ significantly by stage. Several noninvasive imaging studies and invasive tests are available. Understanding the accuracy, advantages, and disadvantages of the available methods for staging non-small cell lung cancer is critical to decision-making.
Target Patient Population
Patients with non-small cell lung cancer
Inclusion Criteria
Female, Male, Adolescent, Adult, Older adult
Health Care Settings
Ambulatory, Hospital, Operating and recovery room, Outpatient, Radiology services
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Management
Diseases/Conditions (MeSH)
D002289 - Carcinoma, Non-Small-Cell Lung, D001706 - Biopsy, D009367 - Neoplasm Staging, D044963 - Biopsy, Fine-Needle
Keywords
lung cancer, staging, non-small cell lung cancer, biopsy, positron emission tomography (PET), Non Small Cell Lung Cancer, non_small_cell_lung_cancer
Methodology
Number of Source Documents
337
Literature Search Start Date
January 1, 1991
Literature Search End Date
June 1, 2012