Figures
- FIGURE 1
Illustration of value of detection of positron emission tomography (PET)-occult lymph node metastases in patient 1, where nodal station 4R was PET negative but transbronchial needle aspiration (TBNA) demonstrated malignant involvement. a) Endobronchial ultrasound (EBUS)-guided TBNA and PET-planned radiotherapy. b) PET-only planned radiotherapy. The area in red is the planning target volume.
- FIGURE 2
Sagittal view illustrating dose distribution with endobronchial ultrasound (EBUS)-proven malignancy (blue) receiving negligible doses of radiation; positron emission tomography (PET)-positive disease (yellow) received a high dose (>57 Gy).
Tables
- TABLE 1
Patient demographics and staging information
Patient Site Pathology EBUS-sampled stations Stations sampled n EBUS positive EBUS negative Discrepant sites# Upstaged 1 RLL Adenocarcinoma 7, 4R 2 7, 4R None 4R 2 RUL NSCLC Pre-carinal, 7, 2R 3 Pre-carinal 7, 2R 4R 3 Left hilum Squamous 7, LLL, 4L 3 7, LLL 4L 7 4 RUL Adenocarcinoma 4R, 7, 11R 3 7, 11R 4R 7 Downstaged 5 RLL Squamous 4R, 7 2 7 4R 2R, 4R 6 RLL Squamous 4L, 2R, 4R, 2L, 7, 11R 6 7, 11R 4L, 2R, 4R, 2L 2L, 4L, 2R, 4R 7 RLL NSCLC 4R, 4L, 11R, 7 4 11R, 7 (atypia) 4R, 4L 4R, 4L 8 RLL NSCLC 4R, 4L 2 4R, 4L None 2R 9 RUL Squamous 4R, 7, 10R 3 7, 10R 4R 2R, 4R 10 RUL NSCLC 2R, pre-carinal, 4R, right hilum 4 Pre-carinal 2R, 4R, right hilum 2R EBUS: endobronchial ultrasound; RLL: right lower lobe; RUL: right upper lobe; NSCLC: non-small cell lung cancer. #: between positron emission tomography-computed tomography and EBUS-guided transbronchial needle aspiration.
- TABLE 2
Target and organ at risk doses
EBUS-upstaged# EBUS-downstaged¶ EBUS-TBNA+PET PET EBUS-TBNA+PET PET PTV D95% Gy 58.1±2.7 16.3±3.3 59.7±0.6 58.6±1.1 Mean heart Gy 10.9±7.9 8.4±7.4 12.2±3.5 15.9±8.4 Mean oesophagus Gy 18.5±5.6 12.0±5.7 16.6±10.4 29.1±5.2 Lung NTCP % 9.6±2.0 7.6±1.5 12.6±5.3 18.3±5.3 Data are presented as mean±sd. EBUS: endobronchial ultrasound; TBNA: transbronchial needle aspiration; PET: positron emission tomography; PTV: planning target volume; D95%: treatment volume receiving >95% of planned dose; NTCP: normal tissue complication probability. #: EBUS-positive/PET-negative, n=4, dose was changed; ¶: EBUS-negative/PET-positive, n=4 (because two out of six patients where EBUS identified a lesser extent of lymph node disease could not reasonably be encompassed within a radical radiotherapy field when planned based on PET alone and therefore plans were not created), potential change in dose.
