Mediastinal Nodal Evaluation May Be Safely Omitted in Select Patients With Ground Glass-Dominant Lung Adenocarcinoma

In the article that accompanies this editorial, Dr. Zhang and colleagues report on a randomized controlled trial in which patients with cT1N0 invasive adenocarcinoma with a consolidation-to-tumor ratio (CTR) ≤ 0.5 were randomized to undergo systematic mediastinal nodal sampling vs. no mediastinal nodal evaluation at the time of segmentectomy or lobectomy; disease-free survival, safety outcomes, and rates of nodal metastases were assessed. No patient in either group was found to have nodal metastases, reinforcing the indolent nature of ground glass predominant adenocarcinoma and suggesting that for well-selected patients, mediastinal nodal sampling may be omitted without adverse oncologic outcomes.