[Correspondence] Invasive mediastinal staging is irrelevant for PET/CT positive N2 lung cancer if the primary tumour and ipsilateral lymph nodes are resectable

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There is a prevailing view held by guidelines that exist across Europe and the USA that detailed and comprehensive mediastinal lymph node staging is a prerequisite to select patients for treatment. Complicated pathways have proposed to maximise the clinical performance and define the role of endobronchial ultrasound transbronchial needle aspiration and mediastinoscopy for mediastinal lymph node biopsy in the diagnostic and staging pathway emphasising the need to confirm negative PET/CT results.1–3 A fairly common flaw when constructing patient pathway algorithms in this setting is a thought process based on sequential diagnostic test performance in clinical subsets rather than working backwards from clinical use (ie, the treatment selections for why the test is performed).