Role of mediastinal staging of lung cancer.

The Lung Cancer Study Group (LCSG) assured objective surgical/pathologic staging of clinical trial patients by requiring histologic examination of lymph nodes from anatomically identified specific mediastinal locations. Therefore, within the larger population of heterogeneous patients with lung cancer, subsets of more homogeneous patients were identified. The addition of mediastinal exploration and removal of lymph nodes to the intraoperative procedure did not increase patient morbidity or mortality. The clinical trials designed using surgical/pathologic mediastinal lymph node staging provided definitive answers to several important questions relative to adjuvant and neoadjuvant treatment of patients with non-small cell lung cancer. The LCSG recommended that objective histopathologic mediastinal lymph node staging be accepted as the standard of care for patients with lung cancer.