Role of Computed Tomography and Mediastinoscopy in the Staging of Lung Cancer: A Canadian Opinion Poll

OBJECTIVES: To address the Canadian Lung Oncology group’s recently published results and recommendations suggesting that mediastinoscopy is unnecessary in the staging nonsmall cell lung cancer when computed tomography shows no enlarged mediastinal lymph nodes (larger than 1 cm in short axis); to evaluate the practice of thoracic surgeons across Canada in staging presumably operable lung cancer; and to assess the effect of the Canadian Lung Oncology Group’s recommendations on current thoracic surgical practice in Canada. DESIGN: A survey of Canadian thoracic surgeons (n=38) regarding the roles of computed tomography and mediastinoscopy in evaluating mediastinal disease in patients with operable lung cancer. RESULTS: There was an 89% response rate. Ninety‐one per cent of surgeons used computed tomography routinely, but only 10% of surgeons thought it to be more accurate than mediastinoscopy. Sixty‐eight per cent would rely on a negative scan (nodes smaller than 1 cm in shortest diameter) to rule out mediastinal disease. CONCLUSIONS: There are numerous circumstances where negative computed tomography does not adequately assess nodal status. A guideline for the use of computed tomography and mediastinoscopy in evaluating and staging lung cancer is presented. Mediastinoscopy should be considered in the staging of patients with negative computed tomography if the patient is at high risk of mediastinal disease, where negative computed tomography is typically unreliable and when the risk associated with an unnecessary thoracotomy is high.