TY - JOUR T1 - N3 hilar sampling decision in the staging of mediastinal lung cancer JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00116-2021 SP - 00116-2021 AU - J. Bordas-Martinez AU - J. L. Vercher-Conejero AU - G. Rodriguez-GonzáLez AU - N. Cubero AU - R. M. Lopez-Lisbona AU - M. Diez-Ferrer AU - R. Tazi AU - A. Rosell Y1 - 2021/01/01 UR - http://openres.ersjournals.com/content/early/2021/06/17/23120541.00116-2021.abstract N2 - The guidelines [1–4] on invasive staging for lung cancer recommend endoscopic ultrasound-guided fine-needle aspiration over surgical staging in patients with a high suspicion of lymph node involvement, either by morphological criteria (>1 cm in short axis) on CT or metabolic criteria on PET uptake (SUVmax [Standardised uptake value maximum]>2.5). This recommendation is also valid for a CT and PET negative mediastinum if there is a central tumor, N1 disease, a low uptake tumor, or a T2 tumor (>3 cm). Systematic endoscopic ultrasound node assessment should include the abnormal nodes by CT or PET and a minimum of three N2 stations (4R, 7, and 4L) [1–4]. Any node more than 5 mm in short axis diameter at endoscopic assessment should be sampled. These recommendations are based on a number of studies that compared cervical mediastinoscopy to EBUS in surgical patients [3, 5], which means that information on N3 hilar lymph nodes (stations 10 and 11) is lacking. There are no specific statements regarding whether or not to sample hilar N3 lymph nodes [1–4]. As Murgu [6] pointed out, routinely sampling these stations may not be warranted because N3 hilar stations do not impact staging if N3 mediastinal stations are positive and because thoracic surgeons only sample N3 mediastinal stations in surgical staging. This study aims to determine the value of this extended clinical practice and to establish whether a higher SUV max cut-off point can provide better PET-CT diagnostic accuracy.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: Dr. Bordas-Martinez has nothing to disclose.Conflict of interest: Dr. Vercher-Conejero has nothing to disclose.Conflict of interest: Dr. Rodriguez-González has nothing to disclose.Conflict of interest: Dr. Cubero has nothing to disclose.Conflict of interest: Dr. Lopez-Lisbona has nothing to disclose.Conflict of interest: Dr. Diez-Ferrer has nothing to disclose.Conflict of interest: Dr. Tazi has nothing to disclose.Conflict of interest: Dr. Rosell has nothing to disclose. ER -