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M. Kirshner
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P1.04 - Poster Session/ Biology, Pathology, and Molecular Testing (ID 233)
- Event: WCLC 2015
- Type: Poster
- Track: Biology, Pathology, and Molecular Testing
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.04-016 - Assessment of the Adequacy of Tissue Diagnosis by EBUS in Relation to the PET Scan and the Operator's Experience (ID 3101)
09:30 - 09:30 | Author(s): M. Kirshner
- Abstract
Background:
Lung cancer remains the leading cause of cancer related death in USA and around the world. Multiple modalities are available for sampling lung neoplasms, mediastinal and hilar lymph nodes . Endobronchial ultrasound –guided transbronchial needle aspiration (EBUS-TBNA) has become an important diagnostic tool . Although the samples obtained by EBUS-TBNA are smaller than specimens collected by other surgical methods, the procedure has shown excellent specificity and sensitivity for the diagnosis of neoplastic diseases, is cost-effective compared to mediastinoscopy , and has become the procedure of choice for initial evaluation of patients with mediastinal and hilar lymphadenopathy . EBUS is currently performed by both interventional and general pulmonologists. Aim of the study: To assess the adequacy of tissue for diagnosis in relevance to PET scan, the diagnostic yield of the various lymph node (LN) stations and the level of experience of the operator.
Methods:
We reviewed the chart of 171 patients who underwent EBUS between the years of 2011-2013. We reviewed the pathological diagnosis, the LN stations, the PET scan results and the operator who performed the EBUS.
Results:
We included 171 patients where adequacy of tissue diagnosis was achieved by majority of patients in whom EBUS was performed (p<.0001). More tissue seemed to be positive in LN station 4 compared to the other LN stations but with no statistical significance. There was no correlation between the positivity of the PET scan and the tissue adequacy for diagnosis by EBUS (p=0.6410). PET scan showed a trend to increase in positive uptake in LN station 2 (p=0.0705). The adequacy of tissue diagnosis was achieved most significantly by Interventional Pulmonary (IP) trained operator, followed by an operator of more than 5 years’ experience followed by an operator of less than 5 years’ experience with 100% ‚ 93.33% ‚ 88.89% subsequently for tissue diagnosis accuracy (p=0.0019). The diagnostic tissue adequacy had a positive correlation with the PET scan when analyzed by operator, where the operator with more than five years’ experience had a closer correlation with the PET scan positive uptake. The percentage of tissue adequacy in relation to the PET scan positive uptake was of 54.64% ‚ 76.67% and 35.56% subsequently (p=0.0009).
Conclusion:
The adequacy of tissue diagnosis was achieved by majority of patients in whom EBUS was performed. There was no correlation between the positivity of the PET scan and the tissue adequacy for diagnosis by EBUS therefore PET scan and EBUS should be used complementary to each other for the appropriate diagnosis and staging of patients. The adequacy of tissue diagnosis was achieved most significantly by (IP) trained operator, followed by an operator of more than 5 years’ experience followed by an operator of less than 5 years’ experience.
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P3.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 208)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.01-037 - Impact of Endobronchial Stents on Patients with NSCLC and Central Airway Obstruction (CAO) (ID 819)
09:30 - 09:30 | Author(s): M. Kirshner
- Abstract
Background:
Approximately 30% of lung cancer patients develop central airway obstruction (CAO) increasing the risk of post-obstructive pneumonia and respiratory failure. Therapeutic interventional bronchoscopy including airway stenting (AS) can provide immediate and effective palliation to improve patient quality of life (QoL). Unfortunately, there is little data about the impact on OS or the risk of hospitalization in patients with CAO mandating stent placement versus patients with CAO lesions that did not require stent placement.
Methods:
Between 2011-2014, twenty five patients with advanced lung cancer were evaluated by the Interventional Pulmonary (IP) Service at the University of Cincinnati for endobronchial stent placement for CAO. We retrospectively reviewed the OS and the risk of hospitalization in patients with lung cancer with CAO mandating stent placements versus patients who did not have lesions requiring stent placement. Death was considered as the endpoint. Kaplan-Meier method was used to calculate median overall survival and 95% CI. Cox model was used to test the overall survival difference between the patients who need stent and patients who do not need stent adjusted for age and sex. Logistic regression was used to test the hospitalization rate difference between the patients who need stent and patients who do not need stent adjusted for age and sex. Data were analyzed using the SAS ® Version 9.4.
Results:
Between 2011-2014, twenty five patients with advanced lung cancer were evaluated by the Interventional Pulmonary (IP) Service at the University of Cincinnati for endobronchial stent placement for CAO. Eight patients did not require placement of a stent and 17 patients had obstructive lesions that required stenting. Age and gender did not have any impact on the risk of hospitalization or OS of both of these groups of patients. The eight patients whose lesions did not mandate stent placement had a significantly lower risk of hospitalization compared to the 17 patients with CAO requiring a stent (OR 15.9, 95%CI 1.2, 209.1; p =0.035). Patients with advanced NSCLC and CAO that required IP stent placement had a median OS of 424 days (95%CI, 119-606 days) compared to a median OS of 729 days (95%CI, 426-. days) for patients with CAO not requiring a stent. Even with a lower survival in patients with stent placement, their OS of 424 days was slightly longer than the reported one-year survival for patients with stage IV NSCLC suggestive of improved outcome of patients with advanced stage NSCLC supported by IP.
Conclusion:
Lung cancer patients with less severe CAO have a lower risk of hospitalization and have better OS compared to patients with CAO mandating stent placement; however, CAO patients with IP evaluation and management in addition, may have improved OS suggesting that IP consultation may offer both improvements in QoL and OS to patients with advanced NSCLC and CAO.
