Assessing the ability of MRI in lung cancer mediastinal staging: rationale and preliminary results

Mediastinal lymph nodes staging in known or suspected lung cancer is now established as standard of care. In many cases nodal disease is radiographically obvious while others are not so evident and further invasive evaluations are required for appropriate treatment selection. In our analysis, an alternative approach to mediastinal staging was considered by emphasizing the potential role of magnetic nuclear imaging (MRI) as useful tool to assess mediastinal stage. In this retrospective preliminary series we considered 7 male patients diagnosed with lung cancer from the Respiratory Unit of IRCCS Policlinico San Matteo. The average age was 68.1 and the average Charlson Comorbidity Index was 5. In 5 cases the hystological diagnosis was obtained through CT scan-guided fine needle aspiration cytology (CT-FNA), in 1 case by endoscopic endobronchial biopsies and in the remaining 1 by endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA). three patients were diagnosed with adenocarcinoma, 2 with squamous-cell carcinoma and 2 with poorly differentiated carcinoma. Considering the N staging, 4 were N2 and 3 were N0, all confirmed by EBUS-TBNA sampling. No mutation for targeted- therapy has been found in any of these patients. In all patients with nodal disease MRI imaging was suggestive for tumour infiltration. We consider a potential role of non-invasive investigations of nodal disease especially in those patients in which node sampling is not indicated or expected. We suggest an Institutional approach and a recommendation to review complex cases at a multidisciplinary level before considering diagnostic and treatment management