Complete Echo-Endoscopic Staging of Lung Cancer vs Surgical Staging: a Randomized Clinical Trial

Inclusion Criteria:

- Consecutive patients with NSCLC or with a clinical suspicion for lung cancer in whom
mediastinal lymph node invasion (either N2 or N3) is suspected based on the available
thoracic imaging

- Pending the results of the mediastinal staging, the patient is otherwise considered a
candidate for a surgical treatment with the intention to cure (this is a resectable
tumor)

- The patient is clinically fit for diagnostic surgery (this is an operable patient)

- No distant metastasis after routine clinical work up

- Provision of a written informed consent

Exclusion Criteria:

- Former therapy (chemotherapy or radiotherapy or surgery) for lung cancer

- Reasons because of which the patient is unable to swallow the EUS-instrument (e.g.
Zenker Divertikel, unexplained esophageal stenosis) or because of which the patient
is unable to undergo a bronchoscopy

- Patients who, based on available thoracic imaging, are unlikely to be staged
accurately by any surgical staging procedure (mediastinoscopy/ - tomy, VATS)

- Respiratory insufficiency or other contra-indications for bronchoscopy

- Concurrent other malignancies

- Uncorrected coagulopathy

- Study cannot be discussed with the patient (e.g. mental disorder)