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In patients with locally advanced NSCLC, systematic endoscopic staging was more accurate than PET alone for defining the extent of mediastinal involvement, prompting researchers to advocate for the routine use of systematic endoscopic staging in clinical practice. In a prospective, multicenter study, Daniel P. Steinfort, PhD, and colleagues systematically assessed mediastinal lymph nodes in patients with locally advanced NSCLC using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) to identify PET-occult metastases. The investigators conducted their study across seven tertiary lung cancer centers in four countries and included 155 patients undergoing combination chemoradiotherapy or high-dose palliative radiotherapy. Systematic endoscopic staging identified PET-occult lymph node metastases in 12% of participants (n=18; 95% CI, 7-17), significantly impacting treatment decisions in all cases. Dr. Steinfort and colleagues also observed discrepancies between PET and EBUS-TBNA findings in 37% of patients (n=57; 95% CI, 29-44). In cases where endoscopic staging identified PET-occult disease, in silico dosimetry studies showed suboptimal tumor coverage with standard PET-based radiotherapy planning.