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Patterns of nodal spread in stage III NSCLC: importance of EBUS-TBNA and (18)F-FDG PET/CT for radiotherapy target volume definition

PURPOSE: The aim of this study was to compare the pattern of intra-patient spread of lymph-node (LN)-metastases within the mediastinum as assessed by (18)F-FDG PET/CT and systematic endobronchial ultrasound-guided transbronchial-needle aspiration (EBUS-TBNA) for precise target volume definition in s...

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Autores principales: Guberina, Maja, Darwiche, Kaid, Hautzel, Hubertus, Pöttgen, Christoph, Guberina, Nika, Gauler, Thomas, Ploenes, Till, Umutlu, Lale, Theegarten, Dirk, Aigner, Clemens, Eberhardt, Wilfried E. E., Metzenmacher, Martin, Wiesweg, Marcel, Karpf-Wissel, Rüdiger, Schuler, Martin, Herrmann, Ken, Stuschke, Martin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8442338/
https://www.ncbi.nlm.nih.gov/pubmed/34526050
http://dx.doi.org/10.1186/s13014-021-01904-4
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author Guberina, Maja
Darwiche, Kaid
Hautzel, Hubertus
Pöttgen, Christoph
Guberina, Nika
Gauler, Thomas
Ploenes, Till
Umutlu, Lale
Theegarten, Dirk
Aigner, Clemens
Eberhardt, Wilfried E. E.
Metzenmacher, Martin
Wiesweg, Marcel
Karpf-Wissel, Rüdiger
Schuler, Martin
Herrmann, Ken
Stuschke, Martin
author_facet Guberina, Maja
Darwiche, Kaid
Hautzel, Hubertus
Pöttgen, Christoph
Guberina, Nika
Gauler, Thomas
Ploenes, Till
Umutlu, Lale
Theegarten, Dirk
Aigner, Clemens
Eberhardt, Wilfried E. E.
Metzenmacher, Martin
Wiesweg, Marcel
Karpf-Wissel, Rüdiger
Schuler, Martin
Herrmann, Ken
Stuschke, Martin
author_sort Guberina, Maja
collection PubMed
description PURPOSE: The aim of this study was to compare the pattern of intra-patient spread of lymph-node (LN)-metastases within the mediastinum as assessed by (18)F-FDG PET/CT and systematic endobronchial ultrasound-guided transbronchial-needle aspiration (EBUS-TBNA) for precise target volume definition in stage III NSCLC. METHODS: This is a single-center study based on our preceding investigation, including all consecutive patients with initial diagnosis of stage IIIA-C NSCLC, receiving concurrent radiochemotherapy (12/2011–06/2018). Inclusion criteria were curative treatment intent, (18)F-FDG PET/CT and EBUS-TBNA prior to start of treatment. The lymphatic drainage was classified into echelon-1 (ipsilateral hilum), echelon-2 (ipsilateral LN-stations 4 and 7) and echelon-3 (rest of the mediastinum, contralateral hilum). The pattern of spread was classified according to all permutations of echelon-1, echelon-2, and echelon-3 EBUS-TBNA findings. RESULTS: In total, 180 patients were enrolled. Various patterns of LN-spread could be identified. Skip lesions with an involved echelon distal from an uninvolved one were detected in less than 10% of patients by both EBUS-TBNA and PET. The pattern with largest asymmetry was detected in cases with EBUS-TBNA- or PET-positivity at all three echelons (p < 0.0001, exact symmetry test). In a multivariable logistic model for EBUS-positivity at echelon-3, prognostic factors were PET-positivity at echelon-3 (Hazard ratio (HR) = 12.1; 95%-CI: 3.2–46.5), EBUS-TBNA positivity at echelon-2 (HR = 6.7; 95%-CI: 1.31–31.2) and left-sided tumor location (HR = 4.0; 95%-CI: 1.24–13.2). There were significantly less combined ipsilateral upper (LN-stations 2 and 4) and lower (LN-station 7) mediastinal involvements (16.8% of patients) with EBUS-TBNA than with PET (38.9%, p < 0.0001, exact symmetry test). EBUS-TBNA detected a lobe specific heterogeneity between the odds ratios of LN-positivity in the upper versus lower mediastinum (p = 0.0021, Breslow-Day test), while PET did not (p = 0.19). CONCLUSION: Frequent patterns of LN-metastatic spread could be defined by EBUS-TBNA and PET and discrepancies in the pattern were seen between both methods. EBUS-TBNA showed more lobe and tumor laterality specific patterns of LN-metastases than PET and skipped lymph node stations were rare. These systematic relations offer the opportunity to further refine multi-parameter risk of LN-involvement models for target volume delineation based on pattern of spread by EBUS-TBNA and PET. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13014-021-01904-4.
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spelling pubmed-84423382021-09-15 Patterns of nodal spread in stage III NSCLC: importance of EBUS-TBNA and (18)F-FDG PET/CT for radiotherapy target volume definition Guberina, Maja Darwiche, Kaid Hautzel, Hubertus Pöttgen, Christoph Guberina, Nika Gauler, Thomas Ploenes, Till Umutlu, Lale Theegarten, Dirk Aigner, Clemens Eberhardt, Wilfried E. E. Metzenmacher, Martin Wiesweg, Marcel Karpf-Wissel, Rüdiger Schuler, Martin Herrmann, Ken Stuschke, Martin Radiat Oncol Research PURPOSE: The aim of this study was to compare the pattern of intra-patient spread of lymph-node (LN)-metastases within the mediastinum as assessed by (18)F-FDG PET/CT and systematic endobronchial ultrasound-guided transbronchial-needle aspiration (EBUS-TBNA) for precise target volume definition in stage III NSCLC. METHODS: This is a single-center study based on our preceding investigation, including all consecutive patients with initial diagnosis of stage IIIA-C NSCLC, receiving concurrent radiochemotherapy (12/2011–06/2018). Inclusion criteria were curative treatment intent, (18)F-FDG PET/CT and EBUS-TBNA prior to start of treatment. The lymphatic drainage was classified into echelon-1 (ipsilateral hilum), echelon-2 (ipsilateral LN-stations 4 and 7) and echelon-3 (rest of the mediastinum, contralateral hilum). The pattern of spread was classified according to all permutations of echelon-1, echelon-2, and echelon-3 EBUS-TBNA findings. RESULTS: In total, 180 patients were enrolled. Various patterns of LN-spread could be identified. Skip lesions with an involved echelon distal from an uninvolved one were detected in less than 10% of patients by both EBUS-TBNA and PET. The pattern with largest asymmetry was detected in cases with EBUS-TBNA- or PET-positivity at all three echelons (p < 0.0001, exact symmetry test). In a multivariable logistic model for EBUS-positivity at echelon-3, prognostic factors were PET-positivity at echelon-3 (Hazard ratio (HR) = 12.1; 95%-CI: 3.2–46.5), EBUS-TBNA positivity at echelon-2 (HR = 6.7; 95%-CI: 1.31–31.2) and left-sided tumor location (HR = 4.0; 95%-CI: 1.24–13.2). There were significantly less combined ipsilateral upper (LN-stations 2 and 4) and lower (LN-station 7) mediastinal involvements (16.8% of patients) with EBUS-TBNA than with PET (38.9%, p < 0.0001, exact symmetry test). EBUS-TBNA detected a lobe specific heterogeneity between the odds ratios of LN-positivity in the upper versus lower mediastinum (p = 0.0021, Breslow-Day test), while PET did not (p = 0.19). CONCLUSION: Frequent patterns of LN-metastatic spread could be defined by EBUS-TBNA and PET and discrepancies in the pattern were seen between both methods. EBUS-TBNA showed more lobe and tumor laterality specific patterns of LN-metastases than PET and skipped lymph node stations were rare. These systematic relations offer the opportunity to further refine multi-parameter risk of LN-involvement models for target volume delineation based on pattern of spread by EBUS-TBNA and PET. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13014-021-01904-4. BioMed Central 2021-09-15 /pmc/articles/PMC8442338/ /pubmed/34526050 http://dx.doi.org/10.1186/s13014-021-01904-4 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Guberina, Maja
Darwiche, Kaid
Hautzel, Hubertus
Pöttgen, Christoph
Guberina, Nika
Gauler, Thomas
Ploenes, Till
Umutlu, Lale
Theegarten, Dirk
Aigner, Clemens
Eberhardt, Wilfried E. E.
Metzenmacher, Martin
Wiesweg, Marcel
Karpf-Wissel, Rüdiger
Schuler, Martin
Herrmann, Ken
Stuschke, Martin
Patterns of nodal spread in stage III NSCLC: importance of EBUS-TBNA and (18)F-FDG PET/CT for radiotherapy target volume definition
title Patterns of nodal spread in stage III NSCLC: importance of EBUS-TBNA and (18)F-FDG PET/CT for radiotherapy target volume definition
title_full Patterns of nodal spread in stage III NSCLC: importance of EBUS-TBNA and (18)F-FDG PET/CT for radiotherapy target volume definition
title_fullStr Patterns of nodal spread in stage III NSCLC: importance of EBUS-TBNA and (18)F-FDG PET/CT for radiotherapy target volume definition
title_full_unstemmed Patterns of nodal spread in stage III NSCLC: importance of EBUS-TBNA and (18)F-FDG PET/CT for radiotherapy target volume definition
title_short Patterns of nodal spread in stage III NSCLC: importance of EBUS-TBNA and (18)F-FDG PET/CT for radiotherapy target volume definition
title_sort patterns of nodal spread in stage iii nsclc: importance of ebus-tbna and (18)f-fdg pet/ct for radiotherapy target volume definition
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8442338/
https://www.ncbi.nlm.nih.gov/pubmed/34526050
http://dx.doi.org/10.1186/s13014-021-01904-4
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