Beyaz F, Verhoeven RLJ, Schuurbiers OCJ, et al. - Given the significance of lymph node staging in patients with non-small cell lung cancer (NSCLC) for determining prognosis and treatment, researchers here examined the clinical- to pathological agreement of guideline-concordant nodal staging in patients with resectable NSCLC as well as investigated the occurrence and distribution of occult lymph node metastases (OLM). They conducted a retrospective single center cohort study including  390 surgically treated NSCLC patients. Classification of patients into sub-groups for mediastinal staging by PET-CT/CT-scan (IMAGE-group; n = 117) or invasive staging by endobronchial ultrasound and mediastinoscopy (INVAS-group; n = 167) was done. In the two groups, agreement between cN- and pN-stage of 86.3% (IMAGE) and 50.9% (INVAS). Observations revealed frequent occurrence of OLM in clinically N0/N1 NSCLC, as well as in tumors < 3 cm, and in regions out of reach of current staging techniques. They underscored addressing these findings when considering non-surgical treatment or sub-lobar resections for early stage lung cancer.