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P. Robinson



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    MO26 - Anatomical Pathology II (ID 129)

    • Event: WCLC 2013
    • Type: Mini Oral Abstract Session
    • Track: Pathology
    • Presentations: 1
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      MO26.06 - Cell block samples from endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) provide sufficient material for ancillary testing in lung cancer. (ID 3262)

      11:00 - 11:05  |  Author(s): P. Robinson

      • Abstract
      • Presentation
      • Slides

      Background
      Rapid on site examination (ROSE) is encouraged at EBUS-TBNA to improve the yield of this procedure. However, many centres do not have the resources to meet this demand. Due to new therapeutic options in lung cancer, it is not sufficient to merely distinguish between non-small cell lung carcinoma (NSCLC) and small cell lung carcinoma (SCLC). Immunohistochemistry (IHC) distinction where possible is now standard practice, as well additional molecular testing where clinically indicated. We investigated the diagnostic yield of smears vs. cell block and the provision of cellular material for ancillary testing.

      Methods
      A retrospective audit of all EBUS-TBNA procedures performed until the end of July 2012 was undertaken. Diagnostic yield on smears versus cell block was recorded. Cell blocks were reviewed by an experienced pathologist to determine diagnostic accuracy and whether IHC and molecular testing were possible.

      Results
      208 procedures were recorded with 101(48.5%) malignant cases, 81(38.9%) benign cases and 26(12.5%) with insufficient sampling. The average number of passes was 4.5. For malignancies, smear diagnosis was possible in 95% of cases and cell block diagnosis in 93.5% (87/93) of cases. There was sufficient material for IHC in 97.7% (85/87) of malignant cases where required. In 79.3% (69/87) of NSCLCs molecular testing was theoretically possible based on the tumour load of samples obtained.

      Conclusion
      Cell blocks are not inferior to smears for diagnostic accuracy and provide sufficient samples for ancillary testing. However, ROSE assists the physician on how best to manage samples for ancillary testing.

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    P2.24 - Poster Session 2 - Supportive Care (ID 157)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P2.24-026 - Lung cancer pathway at the Royal Adelaide Hospital: Impact of treatment intent and patient location. (ID 1605)

      09:30 - 09:30  |  Author(s): P. Robinson

      • Abstract

      Background
      A previous 2010 audit at the Royal Adelaide Hospital (RAH) found delays in treatment initiation when compared to targets set in the United Kingdom (UK) National Cancer Plan. The aim of this study was to review our performance in 2011 and to explore the impact of curative or palliative treatment intent and rural or urban based location, in order to guide future improvement.

      Methods
      Using a pathology database, we retrospectively reviewed 128 case notes of patients referred to the RAH in 2011 with new histologically confirmed lung cancer. We identified treatment intent, patient location and key dates in diagnosis and treatment by radiation oncology, medical oncology, cardiothoracic surgery or palliative care before calculating median intervals between these points.

      Results
      Figure 1 52% of patients were urban and 48% rural. 45% of patients were treated with curative intent and 55% with palliative intent. Pertinent median intervals include: referral to appointment (appt): 4 days (inpt: 0 days, outpt: 7 days); appt to diagnosis (a) rural outpt :16 days, urban outpt: 10 days (p=0.58); (b) surgical: 21 days, curative outpt CH-R: 7 days (P<0.001); (c) surgical rural 30.5 days, surgical urban 13 days (p<0.001); referral to treatment: 41 days (UK 2006: 41 days, RAH 2010: 48 days, (a) outpt: 54 days, inpt: 21 days (p<0.0001), (b) surgical: 62 days, outpt curative CH-R: 34 days (p=0.81), curative outpt CH-R: 34 days, palliative outpt CH-R: 46.5 days (p=0.79)). Inpts met both UK targets. There are a number of factors contributing to the delays in surgical cases including a higher proportion of cases needing multiple biopsy attempts and requiring CT-FNA, which takes twice as long to obtain as a bronchoscopy. Rural location did not impact on overall time to treatment but delays seen in appointment to diagnosis, in particular the surgical cases.

      Conclusion
      For 2011, the RAH achieved the first UK targets for first appointment to a specialist but did not meet the target set for referral to commencing treatment. Delays were seen in some rural subgroups, necessitating the need for a streamlined rural pathway to assist in managing investigations and appointments. In turn, this will also reduce the number of rural elective admissions. Initiatives to improve time to treatment with curative intent include pre-booking investigations, utilising EBUS for staging and improving access to CT-FNA. A follow up audit including analysis of mortality is being conducted.