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E. Yilmaz



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    O23 - Imaging and Screening (ID 125)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Imaging, Staging & Screening
    • Presentations: 1
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      O23.07 - Comparison of diffusion-weighted magnetic resonance imaging versus<br /> F-18 fluorodeoxyglucose positron emission tomography in the assessment of N2 lymph node metastasis due to non-small cell lung cancer (ID 350)

      17:20 - 17:30  |  Author(s): E. Yilmaz

      • Abstract
      • Presentation
      • Slides

      Background
      To compare the diagnostic efficacies of diffusion-weighted magnetic resonance imaging (DWI) and F-18 fluorodeoxyglucose positron emission tomography (PET) findings for the preoperative prediction of mediastinal nodal metastasis in stage N2 disease of non–small cell lung cancer (NSCLC).

      Methods
      The study included 68 patients (42 men and 26 women; mean age, 62 years) with a supicious stage N2 due to NSCLC. In all patients, DWI (using a sigle-shot echo-planar sequence with diffusion factor of 0-600 s/mm² at 1.5 Tesla) and PET were performed before surgery. In DWI, a patient was regarded to have stage N2 disease when an ipsilateral mediastinal lymph node showed apparent diffusion coefficent (ADC) value of ≤0.98 s/mm², regardless of nodal size. A node was considered as positive for malignancy, if it showed standardized uptake value (SUV) of 3 or higher by PET. Both DWI and PET images were prospectively evaluated for malignancy on a per-node basis by two observers. Histopathologic results served as the reference standard. N2 disease was decided by using the American Joint Committee on Cancer staging system. The results were compared between the two modalities and statistically significant differences in nodal metastasis between DWI and PET were determined with p<.05 obtained by using the McNemar test or with a generalized estimating equation.

      Results
      Nodes were positive for malignancy in 36 (32%) of 114 nodal stations and 22 (32%) of 68 patients. The N2 staging was correctly diagnosed in 56 (82%) and 52 (76%) patients by DWI and PET (p=.09), respectively. For the depiction of malignant nodes, DWI and PET showed sensitivities of 78% (31 of 40 nodal groups) and 78% (28 of 36), specificities of 93% (69 of 74) and 90% (70 of 78), positive predictive values of 86% (31 of 36) and 78% (28 of 36), negative predictive values of 88% (69 of 78) and 90% (70 of 78) and accuracies of 88% (100 of 104) and 86% (91 of 104), respectively (p=.23, p<.05, p<.01, p=.08, and p=.12). There were nine false-positive interpretations by DWI, compared with eight by PET. Eight false-negative assessments were present on PET images, but only five false-negative results were found in DWI. .Figure 1

      Conclusion
      DWI has a higher specificity for N2 staging of NSCLC compared with PET and has the potential to be a reliable alternative imaging method with an advantage of radiation-free imaging for the preoperative staging of mediastinal lymph nodes in patients with NSCLC.

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    P1.21 - Poster Session 1 - Diagnosis and Staging (ID 169)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Prevention & Epidemiology
    • Presentations: 1
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      P1.21-006 - Diagnostic value of CT fluoroscopy-guided transbronchial biopsy in endobronchially invisible and transthorasically inaccessible nodule/mass of the lung (ID 2408)

      09:30 - 09:30  |  Author(s): E. Yilmaz

      • Abstract

      Background
      To evaluate the usefulness of transbronchial needle biopsy (TBNB) under computed tomography fluoroscopy (CTF) for pulmonary nodule/mass that is invisible at bronchoscopy and not suitable for biopsy using transthoracic approach.

      Methods
      The study included 23 patients (14 men, 9 women and mean age of 57 years) with pulmonary mass/nodule on computed tomography (CT) scans. In all patients, there was no an endoluminal lesion at bronchoscopy previously carried out and transthoracic biopsy was considered to be inappropriate owing to location of the lesion and/or presence of serious emphysema with abnormal pulmonary function test result. The procedure was done in a CT room with a monitor faced to the radiologist, while performing the broncoscopy by a bronchoscopist. CT fluoroscopic real-time scans were used to confirme that the tip of the bronchoscopic needle was exactly inside of the pulmonary target lesion. After the biopsy performed under CTF guidance, the obtaining samples were examined histopathologically.

      Results
      Figure 1 CTF-guided transbronchial biopsy samples were adequate for definitive diagnosis in 19 (83%) patients and inadequate in 4 (17%) patients. Inadequate results were caused by inability to reach the lesion as seen on CTF scans. 15 nodules/masses were diagnosed as malignant, 4 as benign. For malignant lesions, the final diagnoses were adenocarcinoma (n=5), small cell lung cancer (NSCLC) (n=4), non-NSCLC of undetermined cell type(n=2), epidermoid carcinoma (n=2), lymphoma (n=1) and sarcoma (n=1). Among the benign lesions, specific diagnoses were obtained in 2 (%50) patients. Mild to moderate hemoptysis occurred in 4 (17%) patients.

      Conclusion
      CT fluoroscopy-guided transbronchial biopsy is an effective and safe method to obtain the diagnosis of the lung lesion. It seems to be particularly valuable with a real-time guidance in pulmonary nodule/mass which is invisible at bronchoscopy and inappropriate for transthoracic biopsy.