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European Journal of Nuclear Medicine and Molecular Imaging

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Open Access 01-08-2021 | NSCLC | Original Article

Impact of EBUS-TBNA in addition to [¹⁸F]FDG-PET/CT imaging on target volume definition for radiochemotherapy in stage III NSCLC

Authors: Maja Guberina, Kaid Darwiche, Hubertus Hautzel, Till Ploenes, Christoph Pöttgen, Nika Guberina, Ken Herrmann, Lale Umutlu, Axel Wetter, Dirk Theegarten, Clemens Aigner, Wilfried Ernst Erich Eberhardt, Martin Schuler, Rüdiger Karpf-Wissel, Martin Stuschke

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 9/2021

Abstract

Purpose/introduction

[¹⁸F]FDG-PET/CT is the standard imaging-technique for radiation treatment (RT) planning in locally advanced non-small cell lung cancer (NSCLC). The purpose of this study was to examine the additional value of endobronchial-ultrasound transbronchial needle aspiration (EBUS-TBNA) to standard PET/CT for mediastinal lymph-node (LN) staging and its impact on clinical target volume (CTV).

Materials and methods

All consecutive patients with primary stage III NSCLC who underwent [¹⁸F]FDG-PET/CT and EBUS-TBNA prior to RT were analyzed from 12/2011 to 06/2018. LN-stations were assessed by an expert-radiologist and a nuclear medicine-physician. CTV was evaluated by two independent radiation oncologists. LNs were grouped with increasing distance along the lymphatic chains from primary tumor into echelon-1 (ipsilateral hilum), echelon-2 (LN-station 7 and ipsilateral 4), and echelon-3 (remaining mediastinum and contralateral hilum).

Results

A total of 675 LN-stations of which 291 were positive for tumor-cells, were sampled by EBUS-TBNA in 180 patients. The rate of EBUS-positive LNs was 43% among all sampled LNs. EBUS-positivity in EBUS-probed LNs decreased from 85.8% in echelon-1 LNs to 42.4%/ 9.6% in echelon-2/ -3 LNs, respectively (p < 0.0001, Fisher’s exact test). The false discovery rate of PET in comparison with EBUS results rose from 5.3% in echelon-1 to 32.9%/ 69.1% in echelon-2/ -3 LNs, respectively (p < 0.0001, Fisher’s exact test). Sensitivity and specificity of FDG-PET/CT ranged from 85 to 99% and 67 to 80% for the different echelons. In 22.2% patients, EBUS-TBNA finding triggered changes of the treated CTV, compared with contouring algorithms based on FDG-avidity as the sole criterion for inclusion. CTV was enlarged in 6.7% patients due to EBUS-positivity in PET-negative LN-station and reduced in 15.5% by exclusion of an EBUS-negative but PET-positive LN-station.

Conclusion

The false discovery rate of [¹⁸F]FDG-PET/CT increased markedly with distance from the primary tumor. Inclusion of systematic mediastinal LN mapping by EBUS-TBNA in addition to PET/CT has the potential to increase accuracy of target volume definition, particularly in echelon-3 LNs. EBUS-TBNA is recommended as integral part of staging for radiochemotherapy in stage III NSCLC.

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Title: Impact of EBUS-TBNA in addition to [18F]FDG-PET/CT imaging on target volume definition for radiochemotherapy in stage III NSCLC
Authors: Maja Guberina
Kaid Darwiche
Hubertus Hautzel
Till Ploenes
Christoph Pöttgen
Nika Guberina
Ken Herrmann
Lale Umutlu
Axel Wetter
Dirk Theegarten
Clemens Aigner
Wilfried Ernst Erich Eberhardt
Martin Schuler
Rüdiger Karpf-Wissel
Martin Stuschke
Publication date: 01-08-2021
Publisher: Springer Berlin Heidelberg
Keywords: NSCLC
NSCLC
Radiotherapy
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 9/2021
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-021-05204-7

At a glance: The STEP trials

Springer Medicine

Impact of EBUS-TBNA in addition to [¹⁸F]FDG-PET/CT imaging on target volume definition for radiochemotherapy in stage III NSCLC

Abstract

Purpose/introduction

Materials and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose/introduction

Materials and methods

Results

Conclusion

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