Patterns of nodal spread in stage III NSCLC: importance of EBUS-TBNA and
Adult
Aged
Aged, 80 and over
Biopsy, Needle
Carcinoma, Non-Small-Cell Lung
/ diagnostic imaging
Fluorodeoxyglucose F18
Humans
Image-Guided Biopsy
/ methods
Lung Neoplasms
/ diagnostic imaging
Lymphatic Metastasis
Middle Aged
Positron Emission Tomography Computed Tomography
/ methods
Radiotherapy, Image-Guided
/ methods
Ultrasonography
18F-FDG PET/CT
EBUS-TBNA
Lymphatic drainage
NSCLC
Pattern of spread
Radiation
Stage III
Journal
Radiation oncology (London, England)
ISSN: 1748-717X
Titre abrégé: Radiat Oncol
Pays: England
ID NLM: 101265111
Informations de publication
Date de publication:
15 Sep 2021
15 Sep 2021
Historique:
received:
10
06
2021
accepted:
30
08
2021
entrez:
16
9
2021
pubmed:
17
9
2021
medline:
21
1
2022
Statut:
epublish
Résumé
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 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, 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). 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.
Identifiants
pubmed: 34526050
doi: 10.1186/s13014-021-01904-4
pii: 10.1186/s13014-021-01904-4
pmc: PMC8442338
doi:
Substances chimiques
Fluorodeoxyglucose F18
0Z5B2CJX4D
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
176Informations de copyright
© 2021. The Author(s).
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