Department of Pulmonology, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Spain.
Department of Medicine, Medical School, University of Barcelona, Barcelona, Spain.
Respirology. 2020 Nov;25 Suppl 2:37-48. doi: 10.1111/resp.13901. Epub 2020 Jul 12.
Mediastinal staging is a crucial step in the management of patients with NSCLC. With the recent development of novel techniques, mediastinal staging has evolved from an activity of interest mainly for thoracic surgeons to a joint effort carried out by many specialists. In this regard, the debate of cases in MDT sessions is crucial for optimal management of patients. Current evidence-based clinical guidelines for preoperative NSCLC staging recommend that mediastinal staging should be performed with increasing invasiveness. Image-based techniques are the first approach, although they have limited accuracy and findings must be confirmed by pathology in almost all cases. In this setting, the advent of radiomics is promising. Invasive staging depends on procedural factors rather than diagnostic performance. The choice between endoscopy-based or surgical procedures should depend on the local expertise of each centre. As the extension of mediastinal disease in terms of number of involved lymph nodes and nodal stations affects prognosis and the choice of treatment, systematic samplings are preferred over random targeted samplings. Following this approach, a diagnosis of single mediastinal nodal involvement can be unreliable if all reachable mediastinal nodal stations have not been assessed. The performance of confirmatory mediastinoscopy after a negative endoscopy-based procedure is controversial but currently recommended. Current indications of invasive staging in patients with radiologically normal mediastinum have to be re-evaluated, especially for central tumour location.
纵隔分期是治疗非小细胞肺癌（NSCLC）患者的关键步骤。随着新的技术的发展，纵隔分期已从主要为胸外科医生感兴趣的活动演变为许多专家共同参与的活动。在这方面，MDT 会议中的病例讨论对于患者的最佳管理至关重要。目前有术前 NSCLC 分期的基于循证的临床指南建议，纵隔分期应采用逐渐增加侵袭性的方法进行。基于影像的技术是首选方法，尽管其准确性有限，几乎所有情况下都需要通过病理来证实检查结果。在此背景下，放射组学的出现带来了希望。侵袭性分期取决于操作因素而非诊断性能。内镜或手术程序的选择应取决于每个中心的当地专业知识。由于纵隔疾病在受累淋巴结和淋巴结站的数量方面的扩展会影响预后和治疗选择，因此应优先进行系统采样，而不是随机靶向采样。按照这种方法，如果没有评估所有可到达的纵隔淋巴结站，对单一纵隔淋巴结受累的诊断可能不可靠。阴性内镜检查后进行确认性纵隔镜检查的效果存在争议，但目前仍被推荐。目前，对影像学正常纵隔患者进行侵袭性分期的适应证需要重新评估，特别是对于中央肿瘤位置。
