{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T15:34:40Z","timestamp":1774452880115,"version":"3.50.1"},"reference-count":11,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,3,12]]},"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:p>Local recurrence at a surgical staple site is an uncommon but clinically important cause of diagnostic uncertainty during lung cancer surveillance. Although postoperative staple site thickening is frequently encountered, distinguishing benign postsurgical changes from true malignant recurrence can be challenging, particularly when early imaging findings are metabolically inactive. In an elderly woman previously treated with curative right lower lobectomy, imaging identified a small right hilar tissue density adjacent to the surgical staple site. Initial 18F-fluorodeoxyglucose (FDG) positron emission tomography\u2014CT demonstrated no significant metabolic activity; however, interval progression in both size and FDG uptake on serial imaging raised concern for recurrence, highlighting the limitation of relying on SUVmax alone to exclude malignancy. Due to its hilar location and proximity to major vessels, percutaneous biopsy was not feasible. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) enabled minimally invasive tissue confirmation of recurrence of non-small cell lung carcinoma in an anatomically complex postoperative site. After multidisciplinary evaluation, repeat surgery was deemed high-risk; hence, definitive stereotactic body radiation therapy (SBRT) was delivered. The patient tolerated treatment well, with early follow-up imaging showing a reduction in lesion size and metabolic activity, followed by persistent low-level metabolic activity on later surveillance. This case underscores the importance of maintaining a high index of suspicion for staple site recurrence despite initially negative metabolic imaging, the value of tissue confirmation in progressive postoperative lesions, and the role of EBUS-TBNA and SBRT as pragmatic diagnostic and therapeutic options when reoperation is not feasible.<\/jats:p>","DOI":"10.1136\/bcr-2026-272075","type":"journal-article","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T14:31:04Z","timestamp":1774449064000},"page":"e272075","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Late recurrence of non-small cell lung carcinoma at a surgical staple site diagnosed by endobronchial ultrasound and treated with stereotactic body radiation therapy"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8335-1938","authenticated-orcid":false,"given":"Jonni Fay Cayon","family":"Teves","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Pulmonary Medicine, University of the Philippines Manila, Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cary Amiel Gil","family":"Villanueva","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Pulmonary Medicine, University of the Philippines Manila, Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reno Eufemon","family":"Cereno","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of the Philippines-Philippine General Hospital, Manila, Philippines"},{"name":"University of the Philippines Manila College of Medicine, Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6941-9139","authenticated-orcid":false,"given":"Ralph Elvi","family":"Villalobos","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Pulmonary Medicine, University of the Philippines Manila, Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,3,25]]},"reference":[{"key":"2026032507302859000_19.3.e272075.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cllc.2022.12.005"},{"key":"2026032507302859000_19.3.e272075.2","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1016\/j.athoracsur.2023.06.004","article-title":"Recurrence After Complete Resection for Non-Small Cell Lung Cancer in the National Lung Screening Trial","volume":"116","author":"Potter","year":"2023","journal-title":"Ann Thorac Surg"},{"key":"2026032507302859000_19.3.e272075.3","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1513\/AnnalsATS.202111-1302OC","article-title":"Confirmatory Mediastinoscopy after Negative Endobronchial Ultrasound-guided Transbronchial Needle Aspiration for Mediastinal Staging of Lung Cancer: Systematic Review and Meta-analysis","volume":"19","author":"Sanz-Santos","year":"2022","journal-title":"Ann Am Thorac Soc"},{"key":"2026032507302859000_19.3.e272075.4","doi-asserted-by":"crossref","DOI":"10.21037\/med-21-2","article-title":"Diagnostic accuracy of endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) for mediastinal lymph node staging of lung cancer","volume":"5","author":"Torre","year":"2021","journal-title":"Mediastinum"},{"key":"2026032507302859000_19.3.e272075.5","doi-asserted-by":"crossref","first-page":"1930","DOI":"10.21037\/tlcr-20-860","article-title":"Stereotactic radiotherapy for early stage non-small cell lung cancer: current standards and ongoing research","volume":"10","author":"Vlaskou Badra","year":"2021","journal-title":"Transl Lung Cancer Res"},{"key":"2026032507302859000_19.3.e272075.6","unstructured":"National comprehensive cancer network. In: NCCN Clinical Practice Guidelines in Oncology: Non-Small Cell Lung Cancer. Version, 2024."},{"key":"2026032507302859000_19.3.e272075.7","doi-asserted-by":"publisher","DOI":"10.1097\/JTO.0b013e3181c20080"},{"key":"2026032507302859000_19.3.e272075.8","doi-asserted-by":"crossref","first-page":"861","DOI":"10.5603\/RPOR.a2021.0090","article-title":"Target volume definition for staple line recurrences of non-small cell lung cancer","volume":"26","author":"Nuzhat","year":"2021","journal-title":"Rep Pract Oncol Radiother"},{"key":"2026032507302859000_19.3.e272075.9","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.1016\/j.athoracsur.2019.12.065","article-title":"Staple Line Thickening After Sublobar Resection: Reaction or Recurrence?","volume":"109","author":"Sun","year":"2020","journal-title":"Ann Thorac Surg"},{"key":"2026032507302859000_19.3.e272075.10","doi-asserted-by":"crossref","first-page":"26","DOI":"10.21037\/jtd-21-1626","article-title":"Differentiation between staple line granuloma and recurrence after sublobar resection for primary lung cancer","volume":"14","author":"Matsuura","year":"2022","journal-title":"J Thorac Dis"},{"key":"2026032507302859000_19.3.e272075.11","doi-asserted-by":"crossref","first-page":"78","DOI":"10.21037\/tlcr.2018.08.15","article-title":"Stereotactic body radiotherapy as salvage treatment for recurrence of non-small cell lung cancer after prior surgery or radiotherapy","volume":"8","author":"Milano","year":"2019","journal-title":"Transl Lung Cancer Res"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-272075","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T14:31:08Z","timestamp":1774449068000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-272075"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":11,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3,25]]},"published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1136\/bcr-2026-272075"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-272075","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]}}}