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Contemporary Lung Cancer Nodal Staging and Evolving Therapeutic Paradigms

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: 30 September 2026 | Viewed by 1086

Special Issue Editors


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Guest Editor
Department of General Thoracic Surgery, Dokkyo Medical University, Mibu 321-0293, Japan
Interests: lung cancer; interventional pulmonology; surgery

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Guest Editor
Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
Interests: pulmonology; brochoscopy; lung neoplasm
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Special Issue Information

Dear Colleagues,

The ninth edition of the TNM classification revised the nodal staging system by distinguishing between single-station and multi-station N2 disease. However, a standardized definition of “clinical” N staging based on radiologic findings or minimally invasive nodal assessment techniques remains lacking. Consequently, the current clinical TNM staging is largely based on radiologic evaluation. In addition, no formal radiologic criteria exist for defining positive N1 disease; in clinical practice, the N2 criteria—such as a short-axis diameter exceeding 1 cm—are often applied to N1 nodes as well, despite limited validation.

With the advancement of lung cancer therapies, particularly effective neoadjuvant and adjuvant treatments, accurate and reproducible nodal staging has become increasingly important for optimal patient selection and treatment planning. This Special Issue aims to address the current limitations in clinical nodal staging, explore challenges in radiologic and invasive assessment of N1 and N2 disease, and discuss emerging strategies and technologies for achieving more precise diagnosis and treatment in lung cancer care.

Dr. Takahiro Nakajima
Prof. Dr. George A. Eapen
Guest Editors

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Keywords

  • ninth TNM classification
  • nodal staging
  • endoscopic/endobronchial ultrasound
  • neoadjuvant/adjuvant therapy
  • biomarker testing

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Published Papers (1 paper)

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Research

12 pages, 263 KB  
Article
Synoptic Reporting Improves Quality of Endobronchial Ultrasound (EBUS): An Australian Multicentre Study
by Ashleigh Witt, Nicole M. Rankin, Hanson Siu, Nicholas Wilsmore, Shaun Yo, Christopher Lyne, Kexin Sun, Kanishka Rangamuwa, Tracy Leong, Ashleigh Hocking, Shankar Siva and Daniel P. Steinfort
Cancers 2026, 18(10), 1528; https://doi.org/10.3390/cancers18101528 - 9 May 2026
Viewed by 332
Abstract
Introduction: Accurate mediastinal staging with endobronchial ultrasound (EBUS) is essential in determining prognosis and management of patients with non-small cell lung carcinoma (NSCLC). Procedural documentation is often variable and incomplete due to reliance on free-text reporting. Synoptic reporting, which is a structured, [...] Read more.
Introduction: Accurate mediastinal staging with endobronchial ultrasound (EBUS) is essential in determining prognosis and management of patients with non-small cell lung carcinoma (NSCLC). Procedural documentation is often variable and incomplete due to reliance on free-text reporting. Synoptic reporting, which is a structured, standardised approach, improves documentation quality in other specialties, but has not been evaluated in EBUS. This study aimed to evaluate the impact of synoptic reporting on quality metrics in systematic staging EBUS. Methods: This multicentre ambispective study was conducted across five Australian tertiary hospitals. Synoptic reporting was implemented for EBUS procedures where systematic staging is recommended. Outcomes from three months of pre-intervention data were compared with three months post-intervention. The primary outcome was completeness of systematic mediastinal staging. Secondary outcomes included number of lymph nodes sampled per procedure, number of radiologically normal nodes sampled, detection of positron emission tomography (PET)-occult lymph node metastases, and report completeness. Results: Ninety-six procedures were included pre-intervention, and 77 post-intervention. Complete mediastinal staging increased from 17/96 (17.7%) to 67/77 (87%) (OR 3.2; p < 0.001). The mean number of lymph nodes sampled per procedure increased from 1.75 to 2.45 (p < 0.001), and sampling of radiologically normal nodes increased from 37/96 (38.5%) to 55/77 (71.4%) (OR 3.95; p < 0.001). Detection of PET-occult nodal metastases increased from 3/96 (3.1%) to 9/77 (11.7%) (OR 4.07; p = 0.036). Report completeness improved across most mandated domains. Conclusions: Synoptic procedural improves the quality and performance of systematic staging EBUS and represents a scalable quality improvement intervention. Full article
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