N2 disease in non-small cell lung cancer patients, diagnosis and evaluation: a Turkish chest surgeon's perspective.

Mediastinal or N2 disease is the most important factor in selecting the optimal treatment strategy in patients without distant metastasis. A direct surgical resection has not generally been accepted as a treatment modality in whom mediastinal nodal involvement is demonstrated. Patients with lung cancer can be diagnosed as clinical N2 disease based on CT and PET-CT characteristics of the mediastinum and the clinical presentation. Invasive diagnostic modalities used in the detection of N2 disease are: mediastinoscopy, endoesophageal ultrasound guided biopsy (EUS), transbronchial needle aspiration (TBNA), endobronchial ultrasound guided biopsy (EBUS), video-assisted thoracoscopic surgery (VATS), and mediastinotomy/extended mediastinoscopy. In this article, the author discusses about invasive and noninvasive techniques on the evaluation of mediastinal disease and presents his experience on this topic.