Last updated March 15, 2022

Methods For Staging Non-Small Cell Lung Cancer: Diagnosis And Management Of Lung Cancer

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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Recommendation Grading

Overview

Title

Methods For Staging Non-Small Cell Lung Cancer: Diagnosis And Management Of Lung Cancer

Authoring Organization

Publication Month/Year

May 1, 2013

Document Type

Guideline

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