Implications of the 8th TNM Classification on the Bronchoscopist, a future perspective

Primary lung malignancy remains the leading cause of cancer related deaths globally. A better understanding of the disease process with advancing diagnostic modalities has led to a change in the standard of care. Endobronchial ultrasound (EBUS) with transbronchial lymph node needle aspiration allows for mediastinal and hilar lymph node sampling for accurate staging and prognostication.  In the latest 8^th edition of the TNM classification, several changes were made including redefining T based on size, redefinition of metastasis (M) and changes were made to stage groupings. Nodal staging has remained the same as of the 7^th edition of the TNM classifications. In this review, we are reemphasizing the importance of the extra step of nodal staging and its clinical significance. Furthermore, we highlight the necessity of more aggressive nodal staging using EBUS-TBNA in stage 1 lung cancer.