Surgical staging of non-small-cell lung cancer

Accurate intraoperative assessment of disease extension is an essential component of surgery for non-small-cell lung cancer (NSCLC). Although the size of the primary tumor and invasion of adjacent structures (T descriptor) may be readily determined by the surgeon and pathologist, the presence or absence of tumor within the intrathoracic lymph nodes (N descriptor) can be ascertained only by microscopic examination. Histologic staging relies on the quality of the specimens that are submitted to the pathologist. Thus, care must be taken to ensure that the appropriate specimens are obtained and properly handled. In order to appreciate the technical aspects of the staging procedures, an understanding of pulmonary lymphatic drainage and intrathoracic metastatic patterns is necessary. The information that is derived from the surgical/pathologic staging process is important for three reasons. First, it allows optimal decisions regarding the need for additional therapy. Second, it provides prognostic information. Third, it provides a reproducible method for comparison of different treatment strategies.