Minimally Invasive Staging of N2 Disease: Endobronchial Ultrasound/Transesophageal Endoscopic Ultrasound, Mediastinoscopy, and Thoracoscopy

Multiple methods of minimally invasive evaluation of the N2 lymph nodes have been developed in hope of providing information similar to that obtained by a lymph node dissection, but with less morbidity. This article details four minimally invasive procedures: endobronchial ultrasound and needle biopsy, endoscopic transesophageal ultrasound and needle biopsy, cervical mediastinoscopy and biopsy, and thoracoscopy and biopsy. It discusses the lymph nodes that can be evaluated by these procedures, the limitations of the procedures, additional information the procedures can yield beyond lymph node staging, the procedures' reliability in determining whether cancer is present in the N2 lymph nodes, and, most importantly, the potential cost to the patient in answering that question.