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K. Fong
Moderator of
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IA01 - Multidisciplinary Diagnosis of Lung Cancer in the Era of Molecular Medicine (ID 284)
- Event: WCLC 2016
- Type: Interactive Session
- Track: Biology/Pathology
- Presentations: 4
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IA01.01 - The Role Pathology for Diagnosis and Treatment of Lung Cancer (ID 6514)
11:00 - 11:20 | Author(s): H. Popper
- Abstract
- Presentation
Abstract not provided
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IA01.02 - What Endoscopic Techniques can Contribute for Specimen Acquisition (ID 6515)
11:20 - 11:40 | Author(s): A. Valipour
- Abstract
- Presentation
Abstract not provided
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IA01.03 - What Every Lung Pathologist Needs to Know About Thoracic Surgery (ID 6516)
11:40 - 12:00 | Author(s): H. Hoffmann
- Abstract
- Presentation
Abstract not provided
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IA01.04 - Does Cytological Material Fit All - Lessons from EBUS/Bronchoscopy (ID 6517)
12:00 - 12:20 | Author(s): W. Olszewski
- Abstract
- Presentation
Abstract:
In the diagnosis of lung cancer the primary diagnostic approach is microscopic evaluation of tissue biopsy. However, in many cases the only material for microscopic evaluation is cytological one. There are numerous types of cytological material in evaluation of lung tumors including sputum, bronchial brush, bronchial washing, transthoracic and transbronchial fine needle aspirates. Historically sputum was the most common diagnostic material but at present the most common types of cytological specimen are bronchial brush, and transthoracic or transbronchial FNAB. Nowadays worked out and recognized cytological criteria allows not only to diagnose carcinoma but in majority of cases to specify the histologic type of a tumor. This approach to microscopic diagnosis of lung carcinoma was incorporated to the latest WHO classification of lung tumors (ref). The key reason that cytodiagnosic criteria and terminology were included into WHO classification was that in about 30% cases of lung tumors the cytological specimen is the only material for microscopic evaluation. Similarly to evaluation of small tissue biopsies in cytopathology, in doubtful cases, immunocytochemistry may be implemented to determine histologic type of tumor. Most useful in evaluation of cytological specimen are IHC antibodies with nuclear presentation. (e.g. p40 for squamous cell carcinoma and TTF1 for adenocarcinoma). Cytological material may be utilized in evaluation and in differential diagnosis between primary and metastatic lung tumor. The panel of the antibodies (e.g. CDX2, PSA, Melan A ) may be used to indicate location of primary tumors mainly adenocarcinomas. Since cytological smears are of limited diagnostic value for immunocytochemistry, the so-called cell blocs technique is recommended. This technique allows to use larger panel of antibodies for immunohistochemical evaluation. Cytology become very useful for clinical staging of lung carcinoma routinely utilizing EBUS and EUS technique for obtaining material from parahilar and mediastinal lymph nodes. Cytological criteria are similar to that used for specimens obtained by transthoracic FNAB. In our center practice cooperation with adequately trained thorax surgeons provides adequate material for microscopic evaluation from EBUS and EUS obtained specimens in 94% cases. Currently one of the important task for pathologist in evaluating material from lung carcinoma is adequate selection of the material for molecular test. In case of lung carcinoma or to be specific lung adenocarcinoma â material is selected for evaluation of EGFR and K-RAS mutation. In our experience cytological material particularly fine needle aspirates - fulfill such demands. Percentages of tumors cells in the sample is often even higher than in tissue sections especially in fine needles of peripherally location lesions. Cytological material may be useful in evaluation of EGFR and K-RAS mutation as well as in determination of presence of translocations of ALK and ROS1 using FISH technique. Evaluation of ALK and ROS1 translocation remained in the hands of cytopathologists since the crucial point is the location of translocation in nuclei of tumors cells. Latest challenge for pathologists evaluating lung carcinoma specimen is to determine predictive criteria for immunotherapy in those tumors. At the moment it seems that cytological material may be not satisfactory for adequate evaluation of immunocytochemical expression of PD-L1 and PD-1. In summary cytological material from lung carcinoma is useful in establishing the firm microscopic diagnosis of malignancy, to determine histologic type and to be used for molecular tests. It also allows to differentiated between primary and metastatic lung malignancies as well as determined primary location of metastatic lung carcinoma. Cytological specimens obtained by EBUS and EBUS techniques are very useful in clinical staging of lung carcinoma. Reference Travis WD, Brambilla E, Burke AP, Marx A, Nicholson AG eds. WHO Classification of Tumours of the Lung, Pleura, Thymus and Heart. 4[th] ed. Lyon, France: IARC Press; 2015
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Author of
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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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P1.03-065 - Comparison of the Proposed IASLC 8th TNM Lung Cancer Staging System to the 7th Edition (ID 6230)
14:30 - 14:30 | Author(s): K. Fong
- Abstract
Background:
We performed a validation study of the proposed International Association for the Study of Lung Cancer (IASLC) 8[th] tumour, node, metastasis (TNM) and grouping revisions on the non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) in our Institution, where we are a regular contributor of a subset of cases for the IASLC TNM staging revision projects.
Methods:
Data was collected from the Queensland Cancer Control Analysis Team (QCCAT) Queensland Oncology Online (QOOL) registry of NSCLC or SCLC cases presented to The Prince Charles Hospital (TPCH) between 2000 and 2015. It was validated against Queensland Integrated Lung Cancer Outcomes Project (QILCOP) registry with case identification number, first name, last name, and date of birth. Cases were classified according to IASLC TNM revisions 7[th] edition and then according to the proposed TNM revisions and stage groupings where data available. Kaplan-Meier curves were plotted and survival differences tested with Log-Rank test using SPSS Statistics ver. 23.
Results:
The entire study population consisted of three thousand six hundred and thirty-seven cases. One thousand three hundred and ninety-two non-surgical patients had complete clinical staging and one thousand and fifteen patients with pathological staging were identified. Median survival in clinical staging by the 7[th] edition showed progressive reduction in median survival with increasing Stage (IA:1480, IB:714, IIA:715, IIB:391, IIIA:399, IIIB285, IV:196; days) which was similar in the proposed 8[th] edition staging noting small numbers in IA1 (IA1:1385, IA2:2098, IA3:1004, IB:801, IIA:550, IIB:589, IIIA:448, IIIB285, IIIC:265, IVA:218, IVB:106; days). A similar pattern was reflected in pathological staging 7[th] edition TNM staging (IA:3725, IB:3486, IIA:1796, IIB:1209, IIIA:841, IIIB:587, IV:869; “days) and in the proposed 8[th] edition staging (IA1:1929, IA2:3586, IA3:3804, IB:3640, IIA:2977, IIB:1796, IIIA:949, IIIB:723, IVA:869; “days”). Log-Rank test in all the survival curves were <0.001.
Conclusion:
Conclusions: The proposed 8[th] edition TNM classification appears to be a more refined predictor of prognosis. However, our cohort only had small sample sizes for Stage I cases, which need validation and further hazard ratio and multivariate analysis is recommended. Acknowledgements: patients and staff at TPCH and UQTRC
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P1.05 - Poster Session with Presenters Present (ID 457)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Early Stage NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.05-015 - Genomic Characterisation of Non-Small Cell Lung Cancer in an Australian Population (ID 4052)
14:30 - 14:30 | Author(s): K. Fong
- Abstract
Background:
Lung cancer is a heterogeneous disease with poor prognosis. Genomic variants may predict sensitivity to targeted drug therapies or assist in prognostication. We sought to determine the frequency of driver mutations and gene rearrangements in non-small cell lung cancer (NSCLC) and evaluate the feasibility of the MassARRAY system for multiplexed mutational profiling.
Methods:
A cohort study of 419 fresh-frozen NSCLC tumours was performed (AC, n=370; SCC, n=39; ASC, n=7; LCC, n=3). High-throughput and multiplexed mutational profiling was performed using the MassARRAY genotyping system (Agena Bioscience) (n=419). The OncoFOCUS+KIT panel was used for detecting genomic variants in EGFR, BRAF, KRAS, NRAS and KIT (n=413) and the LungFusion panel for fusion genes involving ALK, RET and ROS1 (n=371). Clinico-pathological associations were evaluated using Fisher’s exact test for categorical data, and T test for continuous data. A p-value of <0.05 (two-tailed) was considered statistically significant.
Results:
At least one genomic variant was detected in 196 (46.8%) cases (n=419). EGFR mutations were identified in 42 cases (10.2%), KRAS in 133 (32.3%), BRAF in 11 (2.7%), NRAS in 4 (1.0%) and no KIT mutations were detected. Gene rearrangements involving ALK, RET and ROS1 were identified in 2 (0.5%), 1 (0.3%) and 5 (1.3%) cases respectively. Based on current clinical guidelines for NSCLC, 28 patients would qualify for tyrosine kinase inhibitor therapy, and 4 for targeted therapy available for other cancers (BRAF V600E). EGFR mutations were significantly associated with adenocarcinoma histology and female never smokers (p<0.001) and KRAS mutations predominated in smokers (p<0.001).
Conclusion:
Driver mutations were detected in 46.8% of NSCLC cases resected at TPCH. Rapid, multiplexed mutation testing can guide treatment as well as assist in patient stratification for clinical trials.
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P2.07 - Poster Session with Presenters Present (ID 468)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Nurses
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.07-005 - Narratives from High Risk Respiratory Patients Who Had Bronchoscopy with Limited Sedation and Analgesia (ID 3733)
14:30 - 14:30 | Author(s): K. Fong
- Abstract
Background:
Bronchoscopy is a standard procedure to investigate and treat respiratory pathology. When patients have high risk respiratory conditions e.g. chronic obstructive pulmonary disease, the administration of sedation and analgesia is often restricted to help prevent respiratory complications. In this study, limited sedation and analgesia was given up to maximum doses of midazolam 5mg and fentanyl 100mcg. Prior to this study, the patient experience of bronchoscopy with limited sedation and analgesia was relatively unexplored. The aim of this study was to explore the patient experience of bronchoscopy with limited sedation and analgesia.
Methods:
A qualitative, interpretive approach was used to collect data, analyse and write up the stories of the 13 participants in the study. Data were collected using unstructured interviews. These were transcribed then analysed phenomenologically (after Van Manen, 1990).
Results:
Bob was scared that he had lung cancer and required a bronchoscopy with biopsy to determine this. During the procedure Bob was aware and heard the doctors say they could not do a biopsy. This made Bob angry and frustrated. John was also aware during his bronchoscopy and remembered coughing and choking during the procedure. John described choking as the worst feeling. Rachel was fearful that the bronchoscopy procedure would be uncomfortable and anticipated throat discomfort with coughing. Rachel expressed feeling unprepared before the procedure resulting in heightened anxiety. She also said the humour of the hospital workers helped relieve her anxiety pre-procedure. Rachel was not aware during her procedure, but suffered a sore throat and aggravation of her asthma post procedure.
Conclusion:
Patients’ experiences of fear dominated the findings. For example, coughing and choking during the procedure may potentially lead to fears that they are impeding the diagnostic process. The fear that they may have lung cancer may elevate levels of anxiety and possibly impact other emotional responses, recollection of instructions and patient education. Fear of the procedure can be reduced with caring and supportive healthcare workers. It is proposed that effective communication may promote appropriate education, support and reduce unrealistic expectations, and ease patient fears. Helpful educational material could include patient experiences of the procedure plus their acceptance of negative experiences in order to obtain a medical diagnosis. Ultimately, improved pharmaceutical interventions and anaesthetic support to improve patient experiences and manage post-procedural problems may be beneficial.
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P3.07 - Poster Session with Presenters Present (ID 493)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Regional Aspects/Health Policy/Public Health
- Presentations: 1
- Moderators:
- Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)
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P3.07-019 - AMDAT Lung, An Ideal Lung Cancer MDT Dataset (ID 5753)
14:30 - 14:30 | Author(s): K. Fong
- Abstract
Background:
The role of multidisciplinary teams (MDTs) is central to lung cancer care in Australia with support at policy level and with the development of a nation-wide lung cancer MDT directory from Lung Foundation Australia. In parallel, the importance of accessible, clinically relevant information from routine data collection in lung cancer (as well as other tumour streams) is receiving increased recognition. MDT meetings increasingly act as central hubs for the co-ordination of lung cancer care and therefore have the opportunity to focus on quality assurance as well as analyses of patterns of care and identification and targeting of evidence-practice gaps. MDT meetings can act as central sources of data collection and analysis and as such a standardized approach to lung cancer MDT data collection in Australia is warranted. This study will present the results of a modified Delphi study, surveying Australian lung cancer clinicians, aiming to finalize an ideal clinical dataset for collection through lung cancer multidisciplinary meetings.
Methods:
A 17-item survey has been circulated to a broad, representative sample of lung cancer clinicians, medical and allied health, in Australia. Clinicians were identified and contacted either as (1) part of a purposive sample or (2) through MDT lead clinicians identified through convenience or through the Lung Foundation Australia Lung Cancer MDT registry. Results of an initial survey will be analyzed and a second-round survey will be circulated to an expert panel drawn from the first-round participants prior to finalization of the dataset.
Results:
The first round of the survey is reaching completion at the time of abstract submission. A total of 98 responses have been received across the two sampling strategies in the 4 weeks since surveys were distributed. Initial data analysis showed a predominance of pulmonary physicians, attendance at MDT weekly more than fortnightly, support for inclusion of most of the variables presented in the survey and a leaning towards MDT presentation of complex/multimodality therapy and stage IIIA cases rather than all cases of lung cancer.
Conclusion:
The findings of the study will support the development of a standard dataset for collection at lung cancer MDT meetings. This dataset will be utilized in future planned studies across multiple sites for targeted data intervention and feedback strategies and analysis of effect on lung cancer outcomes.
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SC13 - Interaction of COPD and Lung Cancer - Consequences for Early Diagnosis and Management (ID 337)
- Event: WCLC 2016
- Type: Science Session
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:A. Meert, K. Zarogoulidis
- Coordinates: 12/06/2016, 11:00 - 12:30, Stolz 1
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SC13.01 - Common Pathogenesis of COPD and Lung Cancer (ID 6649)
11:00 - 11:20 | Author(s): K. Fong
- Abstract
- Presentation
Abstract not provided
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
