Staging of Non-small Cell Lung Cancer

The process of lung cancer staging is getting increasingly complex and requires distinct input from specialized physicians of radiology, nuclear medicine, thoracic surgery, and pathology. Also after the advent of the revised 8th edition of the TNM classification, noninvasive imaging with CT and 18F-FDG-PET, supplemented by MRI, continues to provide the initial basis for clinical staging by determining the anatomic extent of the disease and thus plays a pivotal role in the diagnosis and management of NSCLC. In cases without distant metastatic disease, pretherapeutic mediastinal staging with invasive methods (mediastinoscopy or endoscopic procedures) is mandatory to determine the most appropriate treatment strategy if imaging findings are positive or in certain scenarios that come along with a high risk of false-negative imaging results. The most important limitation inherent to the current TNM staging system is its purely anatomic character that provides insufficient information related to the many different sorts of novel targeted therapies. This translates also to imaging-derived staging of NSCLC in radiology and nuclear medicine, where—besides higher anatomic resolution and image quality—the most important remaining challenge is to gather more “functional” information and generate a more comprehensive picture of the disease by noninvasive staging methods.