Should all patients with non-small cell lung cancer who are surgical candidates have cervical mediastinoscopy preoperatively?

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed is whether all potential surgical candidates with non-small cell lung cancer should have cervical mediastinoscopy pre-operatively. Two hundred and forty-one papers were found using the reported search, of which 8 represented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses were tabulated. We conclude that patients with resectable non-small cell lung cancer who have had a negative mediastinal CT scan should all undergo mediastinoscopy. The number needed to treat with mediastinoscopy to prevent an unnecessary thoracotomy is around 5-15 patients. Exceptions to this may be patients with a T1 tumour, patients with a small peripheral tumour or patients who have had a negative PET scan.