Staging

Cancer Staging (National Cancer Institute)
Provides an overview of staging in cancer and explains what it is and why it is important for treatment and prognosis. Aimed at patients. [1/04]

Noninvasive Staging of NSCLC: The Guidelines (CHEST)
Abstract of the evidence-based lung cancer treatment guideline published by the American College of Chest Physicians (ACCP) in the supplement to the January 2003 issue of CHEST. Stresses that correct staging lung cancer is extremely important because the treatment options and the prognosis differ significantly by stage. Discusses the strengths and weaknesses of several noninvasive imaging studies that aid in identifying disease both within and outside of the chest. Notes that chest CT scanning is useful in providing anatomic detail that better identifies the location of the tumor, its proximity to local structures, and whether or not lymph nodes in the mediastinum are enlarged. Unfortunately, the accuracy of chest CT scanning in differentiating benign from malignant lymph nodes in the mediastinum is unacceptably low. Whole-body positron emission tomography (PET) scanning has much better sensitivity and specificity than chest CT scanning for staging lung cancer in the mediastinum. In addition, metastatic disease can be detected by PET scan. Still, positive findings of PET scans can occur from nonmalignant etiologies (eg, infections), so that tissue sampling to confirm the suspected malignancy must be performed. The clinical evaluation tool, which is composed of a thorough history and physical examination, remains the best predictor of metastatic disease. If signs, symptoms, or findings from the physical examination suggest the presence of malignancy, then sequential imaging should be performed. Unless overwhelming evidence of metastatic disease is present on an imaging study, in situations in which it will make a difference in treatment, all abnormal scan findings require tissue confirmation of malignancy so that patients are not precluded from having potentially curative surgery. Additional recommendations and assessments are included. Aimed at physicians. [1/03]

Invasive Staging: The Guidelines (CHEST)
Abstract of the evidence-based lung cancer treatment guideline published by the American College of Chest Physicians (ACCP) in the supplement to the January 2003 issue of CHEST. Notes that a variety of invasive staging tests are available, including mediastinoscopy, thoracoscopy (video-assisted thoracoscopic surgery), transbronchial needle aspiration (TBNA), transthoracic needle aspiration (TTNA), and endoscopic ultrasound with fine needle aspiration (EUS-NA). The salient issue is to define which procedure is most useful for a particular situation. When confirmation of the diagnosis is the primary issue, TBNA (or EUS-NA, if available) are good choices because of high sensitivity and low morbidity. When the primary issue is to confirm that there is no involvement of mediastinal lymph nodes, mediastinoscopy appears to be best suited to most situations. When the primary goal is to confirm malignant involvement of mediastinal nodes, mediastinoscopy also appears to be best in general, although TBNA, TTNA, and EUS-NA may be reasonable alternatives in certain situations. However, selection of a test will also depend on the local availability of expertise, and patient-specific anatomic and physiologic considerations. Selection of the optimal approach is best achieved through a multidisciplinary discussion so that all aspects can be weighed appropriately. Additional recommendations and assessments are included. Aimed at physicians. [1/03]

Mediastinal Staging of NSCLC (Moffitt Cancer Center)
by Christian Lloyd, MD, and Gerard A. Silvestri, MD 8(4) Cancer Control: JMCC (2001): 311-317
Discusses the various imaging and less invasive modalities currently available to improve staging and therapy decision-making. Argues that CT alone is not sufficiently accurate to stage the mediastinum, and that PET scan, along with mediastinal biopsy techniques using transbronchial needle aspiration or endoscopic ultrasound, has the potential to improve the accuracy of pre-treatment staging. Aimed at physicians. [08/01]

Regional Lymph Node Classification (chestx-ray.com)
Lymph node involvement is of major importance in determining treatment and ultimately survival. Describes regional lymph node classification and provides a lymph node map. [6/00]

"Preoperative Staging of Non-Small Cell Lung Cancer with Positron-Emission Tomography" (New England Journal of Medicine)
v. 343, no. 4 NEJM (July 27, 2000): 254-261
Abstract of study that concludes whole-body positron-emission tomography (PET) improves the rate of detection of local and distant metastases in patients with NSCLC. Implications of the findings are discussed in an accompanying NEJM editorial, "Metabolic Staging of Lung Cancer." [7/00]

"Continuing Controversies in Staging NSCLC: An Analysis of the the Revised 1997 Staging System" (cancernetwork.com)
by Robert J. Ginsberg, MD v.12, no.1 ONCOLOGY (January 1998)
Identifies problems in the current T and N definitions, and inconsistencies in prognosis within the subsets of the various stages of the Revised 1997 Staging System. Calls for worldwide collection of data and analysis before the next revision of the staging system, anticipated in the year 2007. Aimed at physicians. Registration required for free access to cancernetwork.com. [1/98]