3
Diagnosis
Evaluation and Staging
Recommendation 1.1
➤ For patients with suspected stage III NSCLC, an evaluation to
exclude metastatic disease should include, at a minimum: history
and physical exam and computed tomography (CT) scan of chest
and upper abdomen (with contrast, unless contraindicated). (Strong
recommendation; IC-B-L)
Clinical interpretation: Any suspected metastatic site identified on CT should be
confirmed pathologically with biopsy. In general, biopsy sites should be selected to
confirm highest possible disease stage, and to maximize tissue yield.
Recommendation 1.2
➤ Following evaluation with CT scan as per Recommendation 1.1,
fluorodeoxyglucose positron emission tomography (FDG PET)
with CT scan and brain imaging should be performed. (Strong
recommendation; EB-B-H)
Recommendation 1.3
➤ For patients with suspected stage III NSCLC, who are candidates for
curative-intent treatment, mediastinal lymph node status should be
confirmed by pathologic assessment. (Strong recommendation; EB-
B-M)
Recommendation 1.4
➤ For patients who require pathologic assessment of lymph node
status, endoscopic techniques should be offered as the initial staging
modality. (Strong recommendation; EB-B-M)
Recommendation 1.5
➤ For patients who require pathologic assessment of lymph node status
but for whom endoscopic staging is either unavailable or inconclusive,
surgical confirmation of mediastinal stage should be performed.
(Strong recommendation; EB-B-M)
