Appropriate clinical staging of mediastinal lymph nodes in non-small-cell lung cancer (NSCLC) patients has important therapeutic and prognostic implications. Because of the wide variations in practice patterns among community and academic physicians, we reviewed the literature so that we could provide evidence-based recommendations on the use of imaging studies in the pretreatment clinical staging of NSCLC patients. We concluded that the most sensitive and accurate method of noninvasive mediastinal nodal staging is a positron emission tomography/computed tomography fusion scan; we believe this tool should be a component of clinical staging of all NSCLC patients. Given insufficient sensitivity with currently available imaging studies, mediastinal nodal staging should also include histologic evaluation.