Quand et comment réaliser un staging ganglionnaire ?

Abstract

Mediastinal lymph node staging is a critical step in the therapeutic management of non-small cell lung cancer (NSCLC). Advances in functional imaging, particularly PET-CT, have significantly improved non-invasive diagnosis. However, its limited specificity makes histological confirmation essential.

Minimally invasive endoscopic techniques, endobronchial ultrasound (EBUS) ± endoscopic ultrasound (EUS), have emerged as first-line modalities due to their low morbidity and high diagnostic accuracy, especially in patients eligible for curative treatment. These techniques are particularly recommended in cases of radiologically suspicious lymphadenopathy (cN1-N3), central tumors, or large tumors (>3 cm). In the event of negative findings but persistent clinical suspicion, surgical staging via mediastinoscopy remains indicated. Nevertheless, the systematic use of this surgical approach following complete endoscopic staging is increasingly debated in light of recent evidence.

In patients with early-stage NSCLC classified as N0 on PET, invasive staging prior to stereotactic body radiotherapy is not routinely recommended but should be considered on a case-by-case basis, depending on clinical and anatomical risk factors.

Finally, in locally advanced disease treated with neoadjuvant therapy, mediastinal restaging remains a pivotal step in guiding further management. However, it is technically more challenging due to treatment-induced changes such as fibrosis and adhesions, and requires an individualized approach combining both endoscopic and surgical techniques. 1877-1203/© 2025 SPLF. Published by Elsevier Masson SAS. All rights reserved.