Lung cancer remains the deadliest cancer, with more than 160,000 deaths and 226,000 newly diagnosed cases estimated in 2012. Because treatment and survival are directly linked to disease stage, accurate staging in all patients is crucial. The proper staging of early-stage lung cancer involves investigation for the presence of metastatic spread via lymph nodes within the thorax. Initial steps include CT and PET. Mediastinoscopy has previously been considered the gold standard for mediastinal lymph node sampling; however, over the past 10 years the use of ultrasound-guided lymph node sampling has been shown to be at least as sensitive, and has the added advantage of being able to access significantly more stations. This article reviews the current standards of lung cancer staging in 2012.
Christopher Gilbert, Lonny Yarmus, and David Feller-Kopman
Andrew D. Lerner and David Feller-Kopman
With the greater use of chest CT, the incidental detection of lung nodules is expected to increase. However, because most lung nodules are benign, there is a high demand for minimally invasive procedures that provide valuable diagnostic information while minimizing complications. Recent advances in bronchoscopic technology meet this demand. These advanced technologies include navigational bronchoscopy and radial endobronchial ultrasound (EBUS) for the diagnosis of peripheral lung nodules, and linear EBUS, which has revolutionized the nonoperative nodal staging of lung cancer and provides a complementary option to surgical staging approaches. This article reviews these new bronchoscopic technologies.