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

In lung cancer, there is a well-known relationship between the extent of the disease at diagnosis and survival. Staging determines the extent of disease and helps in dividing patients into therapeutic and prognostic groups. The rationale for staging is to select patients who will benefit from surgical resection that remains the best hope for cure. A correct staging includes clinical assessment and proper diagnostic procedures. The tumour, nodes and metastasis (TNM) staging system has been internationally recognized as the standard for staging cancer extension. Clinical stage (cTNM) is related to patient's history, physical examination, laboratory values, radiographic assessment, invasive staging, while the final pathologic stage (pTNM) requires tissue confirmation after surgery. The International Staging System for Lung Cancer has defined patients who are unlikely to benefit from surgical treatment. Therefore it is essential to perform an accurate staging to determine the most adequate treatment for lung cancer patients. This requires a minimally invasive procedure in most instances that may extend to surgical exploration since non invasive techniques up to date do not fulfil all issues. At present an adequate staging strategy demands a combination of different procedures, both invasive and non invasive, to achieve the best results. Debate remains for infrequent clinical presentations and for including comorbidity parameters in staging classification.