Surgical Nodal Sampling Established by Commission on Cancer Standard 5.8 is Essential for Accurate Lung Cancer Staging

Raheem Bell; Amanda B. Francescatti; Daniel Boffa; Timothy W. Mullett; Matthew A. Facktor; Nirmal K. Veeramachaneni; Ryan C. Jacobs; Frank Schneider; Tina J. Hieken; David D. Odell; Ronald J. Weigel

doi:10.1016/j.xjon.2026.101685

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Surgical Nodal Sampling Established by Commission on Cancer Standard 5.8 is Essential for Accurate Lung Cancer Staging

Journal article

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Peer reviewed

Surgical Nodal Sampling Established by Commission on Cancer Standard 5.8 is Essential for Accurate Lung Cancer Staging

Raheem Bell, Amanda B. Francescatti, Daniel Boffa, Timothy W. Mullett, Matthew A. Facktor, Nirmal K. Veeramachaneni, Ryan C. Jacobs, Frank Schneider, Tina J. Hieken, David D. Odell, …

JTCVS open, 101685

02/2026

DOI: 10.1016/j.xjon.2026.101685

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Abstract

Accurate mediastinal staging is critical for the effective treatment of non-small cell lung cancer (NSCLC), as lymph node involvement significantly impacts prognosis and therapeutic decisions. We sought to evaluate the diagnostic accuracy, limitations, and complementary roles of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), cervical mediastinoscopy, and surgical lymph node sampling in mediastinal staging of NSCLC. A systematized literature review was performed using PubMed and national guideline repositories. Studies were included if they reported or provided sufficient data to calculate the negative predictive value (NPV) for EBUS-TBNA, mediastinoscopy, or surgical lymph node sampling. Data were synthesized qualitatively across different clinical scenarios. The pooled (unweighted) NPV of EBUS-TBNA was 93.2% (range 84.7–98%). Mediastinoscopy demonstrated a pooled NPV of 93.8% (range 78.8–97%), with most false negatives attributable to inaccessible stations. Surgical lymph node sampling yielded a pooled NPV of 92.2% (range 83.6–96%) for resected nodal stations, though assessment is limited by variability across studies with inconsistent surgical approaches. These data support the need for systematic intraoperative nodal evaluation to confirm pathologic stage and inform treatment selection. While EBUS-TBNA is the preferred initial staging modality due to its minimally invasive nature, its diagnostic limitations warrant a low threshold for additional nodal evaluation. Systematic intraoperative lymph node evaluation at the time of surgical resection is indispensable for definitive staging, providing clinically actionable data that influences treatment decisions. Optimal staging of NSCLC requires a multidisciplinary, individualized approach that combines modalities based on pre-test probability, imaging findings, and patient factors.

mediastinal

non-small cell lung cancer

sampling

staging

Details

Title: Subtitle: Surgical Nodal Sampling Established by Commission on Cancer Standard 5.8 is Essential for Accurate Lung Cancer Staging
Creators: Raheem Bell - American College of Surgeons
Amanda B. Francescatti - American College of Surgeons
Daniel Boffa - Yale University
Timothy W. Mullett - Markey Cancer Center
Matthew A. Facktor - Geisinger Medical Center
Nirmal K. Veeramachaneni - Saint Louis University
Ryan C. Jacobs - Northwestern University
Frank Schneider - Emory University School of Medicine
Tina J. Hieken - Mayo Clinic
David D. Odell - University of Michigan Medical School
Ronald J. Weigel - American College of Surgeons
Resource Type: Journal article
Publication Details: JTCVS open, 101685
DOI: 10.1016/j.xjon.2026.101685
ISSN: 2666-2736
eISSN: 2666-2736
Publisher: Elsevier Inc
Language: English
Electronic publication date: 02/2026
Academic Unit: Molecular Physiology and Biophysics; Anatomy and Cell Biology; Surgery; Biochemistry and Molecular Biology
Record Identifier: 9985141895302771

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