Invasive staging for lung cancer: which technique for best results?

This publication brings together selected experts whose daily work is dedicated to both research and clinical activity in the field of primary lung cancer. A special effort has been made to select papers which do not simply repeat universally recognized evidence, but which explore either new orientations, or marginal and debatable issues. Part I exposes problems related to early diagnosis and staging, and discusses prognostic factors. We know that lung cancer screening is an issue of ongoing debate in public health, as economists question its cost-efficiency. Detection of indeterminate nodules might even worsen the expenditures. Tumor markers, as evidenced in peripheral blood samples, may contribute substantially to diagnosis and prognosis of lung cancer. Positive tissue diagnosis of primary tumor and draining lymph nodes is of increasing importance because of the introduction of multi-modality treatments, and hence requires invasive staging methods. Part II discusses the different options of surgical treatment. There is no debate that complete surgical resection is the only way to cure a patient suffering from lung cancer. The role of lymph node dissection has considerably increased over the last decade. There is now increasing evidence that a thorough lymph node dissection does not only improve the reliability of staging, but also increases survival.