Staging is of the utmost importance in the evaluation of a patient
with non-small cell lung cancer (NSCLC) because it defines the actual
extent of the disease. Accurate staging allows multidisciplinary
oncology teams to plan the best surgical or medical treatment and to
predict patient prognosis. Based on the recommendation of the
International Association for the Study of Lung Cancer (IASLC), a
tumor, node, and metastases (TNM) staging system is currently used
for NSCLC. Clinical staging (c-TNM) is achieved via non-invasive
modalities such as examination of case history, clinical assessment
and radiological tests. Pathological staging (p-TNM) is based on histological
examination of tissue specimens obtained with the aid of invasive
techniques, either non-surgical or during the intervention. This
review is a critical evaluation of the roles of current pre-operative staging
modalities, both invasive and non-invasive. In particular, it focuses
on new techniques and their role in providing accurate confirmation
of patient TNM status. It also evaluates the surgical-pathological
staging modalities used to obtain the true-pathological staging for NSCLC
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