The role of VATS for staging and diagnosis in patients with non-small cell lung cancer.

Video-assisted thoracoscopic surgery is an effective and versatile tool for the diagnosis and staging of patients with lung cancer. Despite advances in imaging technology, including integrated positron emission tomography/computed tomography scans, the clinical staging of patients with lung cancer remains inaccurate. Tissue confirmation is critical for accurate staging and treatment of patients with lung cancer. Thoracoscopy is an excellent and often preferred approach to the biopsy of inferior mediastinal, anteroposterior window, and para-aortic lymph nodes, and has the added advantage of allowing simultaneous assessment of the pleural space, satellite lung nodules, and T status of the tumor. Thoracoscopic wedge resection is the preferred technique for diagnosing indeterminate solitary pulmonary nodules. In the era of computed tomography screening, most indeterminate lung nodules are less than 1 cm in size and pose unique challenges in determining malignant potential and obtaining a tissue diagnosis. Several techniques have been adopted to allow successful thoracoscopic biopsy of these subcentimeter lung nodules.