Invasive mediastinal staging of non-small-cell lung cancer: a clinical practice guideline

Abstract

Introduction: In non-small-cell lung cancer (nsclc), invasive mediastinal staging is typically used to guide treatment decision-making. Here, we present clinical practice guideline recommendations for invasive mediastinal staging in nsclc patients who have been staged T1-4, N0-3, with no distant metastases.

Methods: Draft recommendations were formulated based on the best available evidence gathered by a systematic review and a consensus of expert opinion. The draft recommendations underwent an internal review by clinical and methodology experts, and an external review by clinical practitioners through a survey assessing the clinical relevance and overall quality of the guideline. Feedback from the internal and external reviews was integrated into the clinical practice guideline.

Results: In general, most clinical experts agreed with the guideline, approving it for methodologic rigour. More than 80% of the surveyed practitioners gave it a high quality rating. The expert reviewers also provided written comments, with some of the suggested changes being incorporated into the final version of the guideline.

Conclusions: In the clinical practice guideline, invasive mediastinal staging of nsclc is recommended in all cases except those involving patients with normal-sized lymph nodes, negative combine positron-emission tomography and computed tomography, and peripheral clinical stage 1A tumour. When performing mediastinoscopy, 5 nodal stations (2R/L, 4R/L, and 7) should routinely be examined.

Keywords: Non-small-cell lung cancer; clinical practice guideline; mediastinal staging; nsclc.

FIGURE 1

Invasive mediastinal staging recommendations. This algorithm applies to the target population of non-small-cell lung cancer patients in Ontario who have been clinically staged T1–4, N0–3, with no distant metastases. ^a Stage 1A: T1N0M0 (T1: primary tumour diameter 3 cm or smaller and surrounded by lung or visceral pleura, or endobronchial tumour distal to the lobar bronchus; N0: no lymph nodes involved; M0: no metastases). ^b For the purposes of this guideline, a tumour in the central third of the hemithorax is considered central. A tumour in the distal two thirds of the hemithorax is considered peripheral. ct = computed tomography; pet = positron-emission tomography.