{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T15:07:56Z","timestamp":1787843276580,"version":"build-2784847793"},"reference-count":44,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2021,2,5]],"date-time":"2021-02-05T00:00:00Z","timestamp":1612483200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,2,5]],"date-time":"2021-02-05T00:00:00Z","timestamp":1612483200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Projekt DEAL"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Nucl Med Mol Imaging"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose\/introduction<\/jats:title>\n                <jats:p>[<jats:sup>18<\/jats:sup>F]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).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Materials and methods<\/jats:title>\n                <jats:p>All consecutive patients with primary stage III NSCLC who underwent [<jats:sup>18<\/jats:sup>F]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).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>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%\/\u00a09.6% in echelon-2\/\u00a0-3 LNs, respectively (<jats:italic>p<\/jats:italic> &lt; 0.0001, Fisher\u2019s exact test). The false discovery rate of PET in comparison with EBUS results rose from 5.3% in echelon-1 to 32.9%\/\u00a069.1% in echelon-2\/\u00a0-3 LNs, respectively (<jats:italic>p<\/jats:italic> &lt; 0.0001, Fisher\u2019s 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.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>The false discovery rate of [<jats:sup>18<\/jats:sup>F]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.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00259-021-05204-7","type":"journal-article","created":{"date-parts":[[2021,2,8]],"date-time":"2021-02-08T15:17:43Z","timestamp":1612797463000},"page":"2894-2903","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Impact of EBUS-TBNA in addition to [18F]FDG-PET\/CT imaging on target volume definition for radiochemotherapy in stage III NSCLC"],"prefix":"10.1007","volume":"48","author":[{"given":"Maja","family":"Guberina","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaid","family":"Darwiche","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hubertus","family":"Hautzel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Till","family":"Ploenes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"P\u00f6ttgen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nika","family":"Guberina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Herrmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lale","family":"Umutlu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel","family":"Wetter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Theegarten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clemens","family":"Aigner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilfried Ernst Erich","family":"Eberhardt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Schuler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R\u00fcdiger","family":"Karpf-Wissel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Stuschke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,2,5]]},"reference":[{"key":"5204_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.radonc.2017.06.003","volume":"124","author":"D De Ruysscher","year":"2017","unstructured":"De Ruysscher D, Faivre-Finn C, Moeller D, Nestle U, Hurkmans CW, Le P\u00e9choux C, et al. 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Guberina M<\/b><sup><b>1<\/b><\/sup><b>, PD MD Dr. med. Guberina N<\/b><sup><b>1<\/b><\/sup><b>; Prof. MD. Dr. med. Umutlu L<\/b><sup><b>6<\/b><\/sup><b>, Prof. MD. Dr. med. Wetter A<\/b><sup><b>6<\/b><\/sup><b>: PD MD Dr. med. Ploenes T<\/b><sup><b>5<\/b><\/sup><b>; PD MD Dr. med. Hautzel H<\/b><sup><b>3, 4<\/b><\/sup><b>; Prof. MD. Dr. med. Theegarten D<\/b><sup><b>7<\/b><\/sup><b>, Prof. MD. Dr. med. Aigner C<\/b><sup><b>5<\/b><\/sup><b>; MD Dr. med. Karpf-Wissel R<\/b><sup><b>2<\/b><\/sup>; There are no relationships\/conditions\/circumstances that present a potential conflict of interest. All authors declare that they have no conflict of interest.<b>Prof. MD. Dr. med. Darwiche K<\/b><sup><b>2<\/b><\/sup><b>:<\/b> KD received travel grants from Olympus and Boston Scientific. There are no relationships\/conditions\/circumstances that present a potential conflict of interest<b>Prof. MD. Dr. med. P\u00f6ttgen C<\/b><sup><b>1<\/b><\/sup><b>:<\/b> Prof. Dr. P\u00f6ttgen reports personal fees from Roche Pharma, personal fees from Boehringer Ingelheim, personal fees from AstraZeneca, outside the submitted work. There are no relationships\/conditions\/circumstances that present a potential conflict of interest<b>Prof. MD. Dr. med. Herrmann K<\/b><sup><b>3,4<\/b><\/sup><b>:<\/b> Prof. Dr. Herrmann reports personal fees from Bayer, other from Sofie Biosciences, personal fees from SIRTEX, non-financial support from ABX, personal fees from Adacap, personal fees from Curium, personal fees from Endocyte, grants and personal fees from BTG, personal fees from IPSEN, personal fees from Siemens Healthineers, personal fees from GE Healthcare, personal fees from Amgen, outside the submitted work. There are no relationships\/conditions\/circumstances that present a potential conflict of interest<b>PD MD. Dr. med. Eberhardt W<\/b><sup><b>8, 9<\/b><\/sup><b>:<\/b>Honoraria (Advisory board function) AstraZeneca, BMS, Roche, MSD, Pfizer, Boehringer, Takeda, Eli Lilly, Bayer, CelgeneHonoraria (educational lectures) BMS, MSD AstraZeneca, Roche, Novartis, Pfizer, Boehringer, Takeda, Abbvie, Celgene, Eli LillyResearch grant Eli Lilly, BMS, AstraZenecaOther noneThe author declares that no competing interests exist.<b>Prof. MD. Dr. med. Schuler M<\/b><sup><b>4, 8, 9<\/b><\/sup><b>:<\/b> Consultant (compensated): AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Novartis, Roche. Honoraries for CME presentations: Abbvie, Alexion, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Lilly, MSD, Novartis, Pierre Fabre.Research funding to institution: AstraZeneca, Boehringer Ingelheim, Bristol-Myers, Squibb, NovartisMS confirms that the above mentioned funding source was not involved in the study design or materials used, neither in the collection, analysis, and interpretation of data nor in the writing of the paper.<b>Prof. MD. Dr. med. Stuschke M<\/b><sup><b>1, 4<\/b><\/sup><b>:<\/b> Honoraria (Advisory board function) AstraZeneca, Bristol-Myers Squibb, Sanofi-Aventis, Janssen-Cilag Research funding to institution by AstraZeneca in 2019 and 2020. Prof. Dr. Martin Stuschke confirms that the above mentioned funding source was not involved in the study design or materials used, neither in the collection, analysis, and interpretation of data nor in the writing of the paper.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}