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D.S. Kim



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    P1.24 - Poster Session 1 - Clinical Care (ID 146)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P1.24-024 - Acute Exacerbation of Idiopathic Interstitial Pneumonia After Resection of Lung Cancer: Investigation of Pre Operative CT predictor (ID 1819)

      09:30 - 09:30  |  Author(s): D.S. Kim

      • Abstract

      Background
      To investigate the ‘preoperative CT predictor’ of postoperative acute exacerbation (AE) of lung cancer with underlying idiopathic interstitial pneumonia (IIP) compared to those without AE as control.

      Methods
      The 78 pulmonary resections for lung cancer with underlying IIP in a single tertiary center, 72 males (92.3%) and 6 females (7.7%), aged from 47 to 80 years old, with a median age of 66 years were retrospectively included. This study was approved by the Institutional Review Board and informed consent was waived. Underlying IIP was retrospectively assessed histological (n=46, 59.0%) and clinico-radiological (n=32, 41.0%) according to ATS/ ERS guidelines. We divided them in two groups, one acute exacerbation (AE group) and the other without acute exacerbation (non AE group) after operation of lung cancer. Records of patients who experienced postoperative acute exacerbation were extracted from the clinical data-base. Two independent expert chest radiologists analyzed CT findings in two times (four data sets) for one month interval. We analyzed age, gender, smoking history and pulmonary function test (PFT) differences between two groups. We analyzed HRCT findings as follows; extent of reticulation, honeycombing, ground-glass opacity, and emphysema in overall extent with area percentage. Fibrotic score (sum of reticulation and honeycombing) was also assessed. We performed the correlation between HRCT findings and presence of acute exacerbation. We used binary logistic regression analysis and student t-test with SPSS 21.0 version as statistics.

      Results
      Of the 78 lung cancer patients, six patients experienced postoperative acute exacerbation (7.7%). Smoking history and PFT between two groups were not significantly different except age and gender. Inter- and intra-reader correlation coefficient were 0.496~0.928 and 0.667~0.936/0.657~0.949, respectively, good to fair. Honeycombing (p=0.001; OR, 1.243; CI, 1.087~1.422) and fibrotic score (p=0.007; OR, 1.188; CI, 1.047~1.347) and abnormal area (p=0.042; OR, 1.059; CI, 1.002~1.119) were significantly high in AE group.

      Conclusion
      Physicians should consider the high extent of honeycombing, as well as high fibrotic score in CT, a potential risk factor for acute exacerbation after pulmonary resection for lung cancer.

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    P3.19 - Poster Session 3 - Imaging (ID 181)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Imaging, Staging & Screening
    • Presentations: 1
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      P3.19-009 - Newly developed early lung cancer during follow-up of idiopathic interstitial pneumonia: serial HRCT observations (ID 1719)

      09:30 - 09:30  |  Author(s): D.S. Kim

      • Abstract

      Background
      To describe HRCT findings of newly developed peripheral T1 lung cancer in idiopathic interstitial pneumonia (IIP) during IIP follow-up

      Methods
      Between November 2001 and October 2012, 66 consecutive patients (62men, 4 women; median age 64, range 40~85 years) who were diagnosed as IIP, fulfilled the American Thoracic Society diagnostic criteria and new cancer (including fourteen small cell) simultaneously, were included. Two radiologists independently reviewed 132 serial CT scans of 66 patients, determined the earliest scan showing lung cancer, and evaluated tumor size (mm), lobar location, axial location on transverse image, shape, and density of tumor. The median interval between null-IIP to new cancer-IIP was measured. Delay in diagnosis was measured from the time of the earliest scan showing lung cancer and the subsequent clinical diagnosis. Formal radiologic reports as ‘first choice’ before diagnosis of cancer were reviewed.

      Results
      The inter-observer agreement was good (Kappa value > 0.77). The median smallest tumor size on axial scan at presentation was 17mm (± 6.57, range, 5-30mm) with T1a/T1b (48/18). Tumor was most commonly located in right lower lobe (29/66, 43.9%), followed by left lower lobe (13, 19.7%). Thirty five tumors (53.0%) were in the interface between normal and fibrotic lung cysts such as honeycomb cysts, twenty two (33.3%) were in the midst of fibrotic lung cysts, and nine (13.6%) were in the normal lung. Fifty nine (83.3%) tumors had round or oval shape, seven (10.6%) tumors had a stellate shape, and two had a band-like shape. Most of the tumors (90.3%) presented as solid density rather than part solid, ground-glass opacity or consolidation. Lung cancers were found during the mean follow-up CT period of 513 days. The median delay in diagnosis was 440 days. Most of the lesions (70%) were interpreted as lung cancer, but nine were interpreted as pneumonia or fungal infection and seven were missed (10.6%) on HRCT.

      Conclusion
      About one third of the tumors were misdiagnosed including missed in ten percents. Over fifty percent of the cancers are located at the interface between normal lung and fibrotic cysts. New lung cancers usually show as tumor with a round or oval shape and solid density.