Mediastinal staging of nonsmall cell lung carcinoma by endoscopic and endobronchial ultrasound-guided fine needle aspiration

Mediastinal staging is of vital importance in the treatment planning of patients with nonsmall cell lung cancer who do not have distant metastases. Nodal assessment is often a challenge, however, and the limitations of staging methods are well recognized. Noninvasive studies can yield a presumptive clinical stage, but invasive tests are often necessary to determine the status of nodes in the absence of extensive mediastinal infiltration. Endoscopic ultrasound-guided fine needle aspiration and endobronchial ultrasound-guided fine needle aspiration are minimally invasive additions to the staging armamentarium that facilitate nodal biopsy under direct visualization without full anesthesia. In some cases, these procedures offer the opportunity for a patient to receive both a tissue diagnosis and staging in one sitting. While their roles are debated and evolving, their availability is increasing and they are reducing the need for surgical staging. Radiologists contribute to the evaluation of patients who may benefit from these up-and-coming procedures and should become familiar with endoscopic ultrasound-guided fine needle aspiration and endobronchial ultrasound-guided fine needle aspiration.