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S. Kumar
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P1.03 - Poster Session with Presenters Present (ID 455)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.03-072 - Mediastinal Lymphnodes Staging by PET CT for Resectable Non-Small Cell Lung Cancer in a Tuberculosis Endemic Country (ID 4155)
14:30 - 14:30 | Author(s): S. Kumar
- Abstract
Background:
Integrated 18 fluorine fluorodeoxyglucose (18F-FDG) PET-CT has shown somewhat variable sensitivity and specificity for nodal staging in tuberculosis endemic areas. This variation mainly because PET scans show falsely increased 18F-FDG uptake in inflammatory nodes, which may be observed in lymph nodes containing calcification or showing higher attenuations than those of surrounding great vessels on unenhanced CT scans. TB is a major health problem in India, incidence is around 2.1 million cases annually.The purpose of the study was to evaluate the efficacy of PET-CT for mediastinal nodal staging in non-small cell lung cancer (NSCLC) patients in a tuberculosis-endemic country.
Methods:
Prospective assessment of the diagnostic efficacy of integrated PET-CT for detecting mediastinal nodal metastasis was performed from February 2012 to February 2016. A total 160 patients underwent surgery for pathologically proven NSCLC. Patients who received chemotherapy or radiotherapy prior to surgery were excluded from study. Thus assessment of the diagnostic efficacy of integrated PET-CT for detecting nodal metastasis was performed in 46 patients (Male to Female ratio:4; mean age- 55 years). Patients underwent an integrated PET-CT examination and subsequent surgical nodal staging. One radiologist and 1 nuclear medicine specialist together prospectively evaluated PET-CT datasets.Nodes showing greater 18F-FDG uptake at PET without benign calcification or high attenuation >70 household unit (HU) at unenhanced CT were regarded as being positive for malignancy. All patients underwent hilar and mediastinal lymph nodes dissection according to the AJCC lymph node map (nodal stations 2R, 4R, 7, 8 and 9 for a right-sided tumour; 4L, 5, 6, 7, 8 and 9 for a left-sided tumour) after resection of the main tumour. Histologic nodal assessment results were used as reference standards. Of these 55 patients, 10 (20%) had a past history of pulmonary tuberculosis as determined by clinical or imaging studies.
Results:
Of 230 mediastinal nodal stations evaluated in 46 patients, 5(2%) stations in 4(8%) patients proved to be malignant by histopathologic assessment. Mean number of lymph node stations evaluated were 5. On a per-nodal station basis, the overall sensitivity, specificity, accuracy, PPV, NPV of PET-CT were 60%, 97%, 96%, 38%,99% for mediastinal lymph nodes staging(N2) respectively.
Conclusion:
Integrated PET-CT provides high specificity and high accuracy, but low sensitivity for mediastinal staging of NSCLCs. The high specificity is achieved at the expense of sensitivity by interpreting calcified nodes or nodes with high attenuation at CT, even with high FDG uptake at PET, as benign in a tuberculosis-endemic region.
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P2.02 - Poster Session with Presenters Present (ID 462)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Locally Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.02-048 - Predictive Factors of Outcome in Locally Advanced NSCLC Patients Treated with Neo-Adjuvant Chemotherapy in Resource-Constrained Settings (ID 5350)
14:30 - 14:30 | Author(s): S. Kumar
- Abstract
Background:
Locally advanced lung cancer is an important cause of cancer-related morbidity and mortality in resource-constrained settings. Investigations and treatment options should be prioritized for optimal management based on availability and cost-effectiveness. We studied the impact of various factors on the risks of recurrence and survival in NSCLC patients undergoing surgery after NACT.
Methods:
We analysed prospectively maintained computerised database of operated carcinoma lung patients. Among 160 patients with NSCLC operated, 40(25%) received NACT. ALl patients underwent staging workup; physical examination, imaging(PET CT or CECT, brain CT), fibrooptic bronchoscopy. Chemotherapy regimen consisted of paclitaxel and carrboplatin for squamous cell carcinoma and pemtrexed based regimen for for adenocarcinoma. The decision of NACT before surgery was taken in multidisciplinary clinic in view of N2 disease or possibility of pneumonectomy. Histopathologic evaluation of gross residual tumour was done and percentage of residual tumour was estimated. Association between clinical, imaging and histopathologic factors with Disease Free Survival(DFS ) was assessed by univariate and multivariate cox propotional hazards model using stata software.
Results:
Median age of cohort was 57 years and male to female ratio 4:1. Squamous cell histology was present in 21 patients. Pathologic complete response(pCR) was achieved in 9 patients(22.9%). Median follow up period was 25 months. All patients with pCR are disease free. Median DFS was 27 months. Median overall survival not reached. Two year survival was 76%. All deaths were cancer related(n=6) and all these patients had post surgery residual N2 disease. Thre were 12 recurrences and all were distant metastasis. Cox regression analysis revealed that major pathological response and post surgery pathological N0/N1 status associated with improved DFS Figure 1
Conclusion:
Neoadjuvant chemotherapy is a feasible in resources constrained settings, result in major pathological response in a proportion of patients with locally advanced NSCLC. Major pathological response and post-surgery pathological N0/N1 status associated with good outcome
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P3.01 - Poster Session with Presenters Present (ID 469)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Biology/Pathology
- Presentations: 1
- Moderators:
- Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)
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P3.01-025 - Primary Pulmonary Sarcomas: An Entity Lost in Misdiagnosis (ID 5930)
14:30 - 14:30 | Author(s): S. Kumar
- Abstract
Background:
Primary pulmonary sarcomas are very rare with an incidence rate of <0.5% of all lung malignancies. Their low incidence has impeded comprehensive evaluation of their association with smoking, definitive diagnostic and treatment-regimes. They are often misdiagnosed, both on radiology as well as on fine-needle-aspirate/small-biopsies. We present a series of primary pulmonary sarcomas diagnosed over the last two and a half years.
Methods:
All cases of primary pulmonary sarcomas (2014-2016) were retrieved and reviewed.
Results:
A total of 21 sarcomas were identified. The most common was synovial sarcoma. Four exceptionally rare cases included pulmonary-artery intimal sarcoma, primary pulmonary myxoid sarcoma, malignant peripheral nerve-sheath tumor and follicular dendritic-cell sarcoma. The clinical and pathology details of which are provided in table1. The patients were distributed over a wide-age range (range:9-65 years, median:34 years) with a male-preponderance (M:F=2.2:1). Radiological features were non-specific except in case1(table1). Histopathology revealed spindle-cell tumor in all cases(figure1) and an extensive immunohistochemical-panel and cytogenetic testing was required to clinch the diagnosis. Figure 1 Figure 2
Conclusion:
This is a series of primary thoracic sarcomas with a highlight on four extremely rare cases which bring to light their unique clinical, radiological, histopathological and immunohistochemical findings. Awareness of such entities is essential for proper diagnosis, appropriate molecular-testing and treatment.
