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M. Chiyo
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P1.16 - Surgery (ID 702)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.16-008 - Near-Infrared Fluorescence-Guided Pulmonary Segmentectomy Following Endobronchial Indocyanine Green Injection (ID 8561)
09:30 - 09:30 | Author(s): M. Chiyo
- Abstract
Background:
Near infrared (NIR) fluorescence-guided pulmonary segmentectomy following endobronchial or intravenous indocyanine green (ICG) administration has been developed and reported. The aim of this study is to prospectively validate the feasibility and safety of NIR fluorescence-guided pulmonary segmentectomy following endobrochial ICG injection using navigational bronchoscopy.
Method:
Patients who underwent pulmonary segmentectomy were prospectively enrolled in this study. Using preoperative CT datasets a 3D image of target segments was reconstructed for lung volumetry and a bronchial road map was created to determine the bronchus for ICG injection. The ICG concentration was 0.125 mg/mL. Immediately after intubation the ICG was injected into the target bronchi using an ultrathin bronchoscope followed by air flushing to expedite ICG dispersion to the periphery. A NIR thoracoscope (PINPOINT, Novadaq) was used to detect ICG fluorescence and determine intersegmental plane for pulmonary segmentectomy. Usefulness and safety of this technique were evaluated by 1) whether ICG demarcation lines correspond to intersegmental lines expected from pulmonary veins, 2) whether large bronchi and vessels in adjacent segments emerge when dividing intersegmental planes using electrical cautery. The patients were followed up to 1 month after surgery to see if any complication existed.
Result:
Eight male and 7 female patients with a mean age of 66.5 ± 9.6 years were enrolled. Segmentectomy regions included right S1, S2, S6, S8 and S10 segments, and left S1+2+3, lingular, S6, S8, S9+10, and basilar segments. The average bronchoscopic procedure time was 14.3 ± 8.0 minutes. Vital signs were kept stable before and after the bronchoscopic procedure. The mean injected volume of ICG solution was 21.2 ± 8.8 mL as per a case. In 13 out of 15 cases (86.7%), NIR fluorescence guidance was recognized as effective for pulmonary segmentectomy. Intersegmental plane could not be determined in 2 cases likely due to insufficient air flushing, leading to the failure of ICG dispersion to the periphery. There was no complications developed intraoperatively. The average operation time was 193 ± 41 minutes, with a mean bleeding of 110 ± 101 mL. The average duration of drainage was 3.1 ± 1.0 days. Recurrent air leakage happened on postoperative day 6 in 1 case. Otherwise, no procedure related adverse event was noted.
Conclusion:
NIR fluorescence-guided pulmonary segmentectomy following endobrochial ICG injection using navigational bronchoscopy appeared to be safe and feasible. Sufficient air flushing may be the key for clear ICG demarcation of referred segments.
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P2.07 - Immunology and Immunotherapy (ID 708)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Immunology and Immunotherapy
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.07-008 - Does PD-L1 Expression of the Archive Surgical Specimen of Primary Tumor Predict the Sensitivity of Recurrence to Nivolumab in Patients with NSCLC? (ID 8041)
09:30 - 09:30 | Author(s): M. Chiyo
- Abstract
Background:
Nivolumab is an immune checkpoint inhibitor targeting human IgG4 programmed death 1 for advanced or recurrent non-small lung cancer (NSCLC), and programmed death ligand 1 (PD-L1) expression of tumor tissue is expected to be a biomarker of the sensitivity to Nivolumab. More recent biopsy is likely to be more suitable since PD-L1 expression of tumor cells is influenced by time or by anti-tumor therapies such as chemotherapy or radiotherapy, and most clinical studies have referred to the PD-L1 expression using the latest biopsy samples before administration of Nivolumab. Therefore, it remains controversial whether PD-L1 expression of the archive specimen obtained at the time of initial surgery for primary disease is correlated with the sensitivity of recurrent diseases to Nivolumab.
Method:
We retrospectively reviewed 10 NSCLC patients who had undergone radical surgery for primary tumor and received Nivolumab for their recurrent diseases. The median interval between the initial surgery and Nivolumab administration was 28.1 months (2-75), and median number of anti-tumor regimens prior to Nivolumab was 2.2 (1-5). Archive specimens of primary tumors and second biopsy samples of recurrent diseases from the 10 patients were stained to measure PD-L1 expression both with the PD-L1 IHC 28-8 pharmDx Daco (assay 28-8), and with the PD-L1 IHC 22C3 pharmDx Daco (assay 22C3).
Result:
Among the 10 patients, complete response (CR)/partial response (PR)/ stable disease (SD)/progressive disease (PD) for Nivolumab were 1/2/3/4 patients, respectively. All patients had PD-L1 expressions as tumor proportion score (TPS)≧1%, of which 7 showed TPS≧10% in the assay 28-8. All 3 patients (30%) with CR/PR showed TPS≧10%. The TPS obtained by assays 28-8 and 22C3 were similar in 9 of 10 patients. Two patients underwent biopsies for their recurrent sites, which showed decreased PD-L1 expression compared with primary tumor, resulted in PD for Nivolumab.
Conclusion:
The PD-L1 expressions of surgical archive specimen might be almost associated with the sensitivity to Nivolumab, however, time and antitumor therapies may modulate the PD-L1 expressions and might be able to affect the sensitivity to Nivolumab. Further pre-clinical and clinical studies are warranted to evaluate the availability of surgical archive specimen in the treatment of postoperative recurrence by the immunocheckpoint inhibition.
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P2.12 - Pulmonology/Endoscopy (ID 713)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Pulmonology/Endoscopy
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.12-006 - Evaluation of New 25G Needle in EBUS-TBNA Comparing Conventional 22G Needle in Diagnosis for Nodal Metastasis of Lung Cancer (ID 10271)
09:30 - 09:30 | Author(s): M. Chiyo
- Abstract
Background:
Dedicated 22G needle is usually used for EBUS-TBNA, which is a main diagnostic tool for nodal staging in lung cancer. Recently new 25G needle is developed and expected less invasive nodal biopsy. Although, diagnostic yield and complication of the EBUS-TBNA using 25G needle are still unclear.
Method:
From September 2016 to May 2017, 39 hilar or mediastinal lymph nodes in 25 patients were consecutively biopsied using both 22G (Olympus, Tokyo, Japan) and 25G (Boston Scientific, MA) needles for diagnosis or staging of lung cancer. Concordance rates of rapid on-site cytologic evaluation and cytological and pathological diagnosis between the EBUS-TBNAs using the two types of needles were evaluated. And also, bleeding score of cytological specimen (0-3: higher is more contaminated) and calculated area of histological core (the number of high-power field microscopically in paraffin-embedded slides) were compared for evaluating sample qualities. The results obtained from EBUS-TBNA using 22G needle were regarded as control to evaluate the diagnostic ability of that using 25G needle in this analysis.
Result:
No complication was recorded during the study period. Thirty three Mediastinal nodes (#2(n=2), #3(n=1), #4R(n=16), #4L(n=2), #7(n=12)) and 6 hilar nodes (#10(n=1), #11(n=3), #12(n=2)) were biopsied and concordance rate between 22G and 25G was 87% (34/39) in the rapid on-site cytologic evaluation, 95% (37/39) in the cytological diagnosis and 85% (35/39) in the histological diagnosis. Final decision whether metastatic or not according to the combined cytologic and histologic diagnosis in the EBUS-TBNA using 22G needle was 19 metastases and 20 benign nodes, and the concordance rate with the two types of needles was 92% (36/39). In the 3 nodes with discrepancy, 2 nodes were diagnosed as lung cancer metastasis by the 25G needle sampling. Both bleeding score and calculated area of histological core showed no significant difference (p=0.3 and 0.7) between 22G and 25G, with respective values of 1.8±0.9 vs. 2.0 ±0.7, and 20±2.2 vs. 21±2.2.
Conclusion:
EBUS-TBNA using 25G needle is feasible and as useful as that using conventional 22G.
