Roundtable Discussion: Mediastinal Staging for Non-Small Cell Lung Cancer

Thank you for this fruitful roundtable discussion on mediastinal staging for lung cancer. In those patients where the chance of negative mediastinoscopy is high (slightly positive PET-CT in a peripheral T1a, or, peripheral T1b or T2 with no CT or PET-CT suspicion marks), would you recommend VATS biopsy and frozen pathological analysis of the mediastinal nodes first, then if there is no metastatic lymph node, proceeding with VATS lobectomy through the same port(s) on the same session instead of doing mediastinoscopy first, then performing VATS lobectomy? I believe it could be time consuming, less invasive for the patient and it saves cost in those situations where the probability of metastatic lymph node by mediastinoscopy is not over 20%. Thank you again for the discussion.

Correction: "...it could be time-saving (not time-consuming)..."