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Mediastinal nodal staging — SCE Respiratory MCQ

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ModerateLung CancerMediastinal nodal stagingSCE Respiratory

A 62-year-old man with stage IIIA NSCLC has PET-positive mediastinal nodes. EBUS samples from stations 4R and 7 are negative, but PET uptake remains high and surgical resection is being considered. What is the most appropriate next step?

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Correct answer: D — Further mediastinal staging with surgical sampling or repeat targeted sampling

Negative EBUS does not fully exclude nodal disease when PET-positive mediastinal nodes remain suspicious and curative surgery is planned; further mediastinal staging is appropriate. Proceeding directly to surgery could understage disease. Treating the nodes as benign ignores the pre-test probability from PET-CT.

Reference: NICE NG122; ESTS Mediastinal Staging Guideline