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P. Thompson
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P1.04 - Poster Session with Presenters Present (ID 456)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Pulmonology
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.04-003 - Incidence of Non-Caseating Granulomas Diagnosed in PET Avid Mediastinal/Hilar Nodes in Patients with Known Breast Cancer (ID 4189)
14:30 - 14:30 | Author(s): P. Thompson
- Abstract
Background:
Breast cancer is known to metastasize to the lung.. Most breast malignancies are clinically staged using radiographic modalities (e.g. PET scans). Importantly, many inflammatory disorders will present similar lymph node FDG-uptake on PET- as that of metastasized breast cancer. The latter confuses the treatment for individuals within whom both undiagnosed autoimmune disorders and breast cancer co-occur. We aim to examine the frequency of non-caseating granulomas diagnosed in PET avid mediastinal/hilar nodes in patients with known breast cancer.
Methods:
Between March 2013 and December 2015, 46 patients diagnosed with breast cancer were staged by PET-CT. Those with positive result in the mediastinum/hilum underwent linear endobronchial ultrasound (EBUS) for pathologic diagnosis and ensuing treatment
Results:
Of the 46 patients with avid mediastinal/hilar adenopathy, 31 (67%) had malignant cytology on EBUS; the remaining 15 had positive PET but negative cytology for malignancy. Twelve of the 15 patients with false positive PET had reactive lymph nodes, and 3 had non-caseating granulomas on cytology (table 1). . Table 1: Results from EBUS Procedure and Resulting Percentage Following Identification of Sarcoid-like Symptoms
Twenty percent of the patients with negative cytology and positive PET had non-caseating granuloma, and 6.5 % of all patients with positive PET had non-caseating granulomas.Total Number of patients in study: n=46 with positive PET Number of patients Percentage of total (all PET positive patients) Percentage among negative patients Positive EBUS 31 67.40% Negative EBUS 12 26.10% 80% Negative/Non-caseating granulomas EBUS 3 6.50% 20%
Conclusion:
Conclusion: This study represents the largest cohort of breast cancer patients, where the incidence of non-caseating granulomas is investigated in PET-positive mediastinal/hilar nodes. We conclude that PET may not be sufficient for staging the mediastinum in patients with breast cancer and, in selected patients, pathologic staging should be done. In addition, the finding of non-caseating granulomas in these patients may either indicate an incidental diagnosis of early stage sarcoidosis, or an inflammatory reaction to the current treatment (sarcomatoid reaction). We also suggest that these patients should be followed for any manifestations of sarcoidosis.
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P2.04 - Poster Session with Presenters Present (ID 466)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Mesothelioma/Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.04-040 - Pleural Effusion Characteristics and Relationship with Outcomes in Cancer Patients (ID 3763)
14:30 - 14:30 | Author(s): P. Thompson
- Abstract
Background:
Pleural effusion is a common occurrence in cancer patients, with an estimated annual incidence of 150,000 in the United States. It generally represents advanced malignant disease with median survival of 3-12 months. It can lead to debilitating symptoms such as dyspnea and pain, adversely affecting the quality of life.
Methods:
We performed a retrospective analysis of a dataset of 62 cancer patients with pleural effusion after first thoracentesis procedure. The recorded data included: age , gender, type of cancer, number of thoracentesis, pleural fluid volume characteristics and volume.
Results:
We studied 62 patients, with ages between 20-77 years, median 57 years; 64% were females and 36% were males. The number of patients deceased by the end of follow up was 43 (69.4%), alive at the end of follow up was 8 (12.9%), lost to follow up 11 (17.7%). Median overall survival was 3 months. The cancer type was divided into breast, 32.3%, non-small cell lung, 25.8% and 41.9% other cancers. Thirty-three (53.2%) patients had malignant pleural effusion with a median of 3 months of survival. Twenty-nine (46.8%) patients had non-malignant effusion with a similar median survival of 3 months. We analyzed the correlation of the radiologically estimated effusion volume, thoracentesis volume and presence of blood and malignant cells with outcomes (overall survival, OS). There is a negative correlation between the radiologically estimated effusion volume and OS (Pearson rank correlation of -0.43). This negative correlation is maintained in subgroup analysis (breast -0.56; lung -0.33). The thoracentesis volume was also negatively correlated with OS (Pearson rank correlation of -0.45), finding also maintained in subgroup analysis (breast -0.39, lung -0.66). We found no statistically significant difference in OS between malignant effusions (average OS 6.1 months, median 3 months) and non-malignant effusions (average OS 4.9 months, median 3 months). There was no statistically significant difference in survival between bloody effusions (average survival 3.5 months, median survival 1.25 months) and non-bloody effusions (average survival 6.2 months, median 3.5 months).
Conclusion:
We found an inverse correlation between the radiologically estimated pleural fluid volumes and OS as well as between thoracentesis volume and OS among cancer patients. This correlation is maintained in subset analysis of the two most common types of cancer in our sample, breast and NSCLC. Survival was not influenced by the presence of malignant cells or blood in the pleural fluid. A prospective study to better characterize the prognostic value of first thoracentesis may be warranted.
