Is nodal biopsy a pre-requisite to surgery in biopsy proven pulmonary adenocarcinoma in the era of PET-CT?

Background/Introduction Lung cancer management is defined by stage and accurate pre-surgical staging is fundamental. The PET scan has become central to this process, but the technology has imperfect sensitivity and specificity. In determining nodal disease in early adenocarcinoma there appears to be a particular dilemma. The different subtypes of adenocarcinoma as per IASLC/ATS/ERS histopathological classification do not behave similarly in PET CTs, leading to increased dependence on staging EBUS or the “gold standard” mediastinoscopy.