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Lymph Node Staging NSCLC — SCE Medical Oncology MCQ

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ModerateLung CancerLymph Node Staging NSCLCSCE Medical Oncology

A 55-year-old man with stage II NSCLC undergoes lobectomy. Intraoperative findings include N1 (hilar) nodes that are macroscopically involved. The surgeon performs systematic mediastinal lymph node dissection. Pathology confirms pT2a pN1 M0. How many lymph node stations must be sampled for adequate staging?

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Correct answer: C — A minimum of 3 mediastinal (N2) stations including subcarinal (station 7) must be sampled — IASLC recommends ≥6 nodes from ≥3 N2 stations for adequate staging

IASLC recommendations for adequate intraoperative lung cancer staging require systematic sampling of at least 3 N2 (mediastinal) stations including station 7 (subcarinal), with a minimum of 6 lymph nodes examined. For right-sided tumours: stations 2R, 4R, 7; for left-sided: 5, 6, 7 (or 4L). Inadequate nodal staging leads to understaging and under-treatment. Systematic lymph node dissection (removing all nodes en bloc) is preferred over sampling in many centres.

Reference: NICE NG122; IASLC Staging Handbook; ESMO 2024 Early NSCLC