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A. Akkoclu



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    P1.02 - Poster Session 1 - Novel Cancer Genes and Pathways (ID 144)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Biology
    • Presentations: 1
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      P1.02-020 - Evaluation Of Gene Expression Profiles For The Differential Diagnosis Of Lung Adenocarcinoma and Malignant Pleural Mesothelioma (ID 2381)

      09:30 - 16:30  |  Author(s): A. Akkoclu

      • Abstract

      Background
      Squamous cell carcinoma is the most commonly diagnosed lung cancer type in Turkey; however lung adenocarcinoma diagnosis has risen among women and nonsmokers. MPM is common in Turkey because of the high asbestos exposition rates. Mostly, lung adenocarcinoma cannot be clearly differentiated from malignant pleural mesothelioma (MPM). Because of The limitations in the immunohistochemical methods there has been a growing interest in the use of gene expression profiling for diagnosis in many cancers. So we aimed to evaluate the gene expression profiles in tumor cells by using RT-PCR array, between two separate groups of lung adenocarcinoma and MPM patients.

      Methods
      Ten newly diagnosed patients with adenocarcinoma and paraffin-embedded tissues of 12 patients with MPM were included in this study without considering gender differences. Eight healthy individual were recruited as a control group. After processing the fresh samples of lung adenocarcinoma stored at -80°C for RNA isolation, cDNA synthesis and the expression of 84 genes were associated with DNA repair were analyzed with RT-PCR Array. Paraffin tissues of patients with MPM were deparaffinized and the same procedure was applied. Fold change values of gene expressions in each group are calculated in “SA Bioscience” data analysis expression page.

      Results
      ACBT, B2N, GADPH AND RPLPO genes were identified as housekeeping genes. Table 1 and 2 shows the comparisons of fold change values ​​of the gene expression differences between lung adenocarcinoma, MPM and control groups.

      Table 1: Fold changes ​​of the gene expressions of lung adenocarcinoma and MPM tumor cells comparing to control group
      Gene Adenocarcinoma/control fold change MPM/control fold change p value (comparing to control group) (adenocarcinoma/MPM)
      APEX2 1,6763 6,1243 >0.05 / >0.05
      BRCA1 9,5919 20,2646 >0.05 / 0,01558
      BRCA2 4,3804 10,8169 >0.05 / 0,012071
      CCNH 2,3922 4,4773 >0.05 / 0,032102
      CDK7 3,909 15,4192 >0.05 / 0,019161
      LIG4 2,2608 13,7822 0,044834 / >0.05
      MLH1 2,5581 7,5515 >0.05 / 0,013792
      MLH3 5,9579 15,4275 >0.05 / >0.05
      MSH3 2,2494 10,2785 >0.05 / >0.05
      MSH4 6,5356 12,0767 >0.05 / >0.05
      NEIL3 14,3334 80,5092 0,015299 / >0.05
      PARP1 0,9019 2,0543 >0.05 / >0.05
      PARP2 4,7127 7,4604 0,043874 /0,009579
      PARP3 2,3613 8,2119 >0.05 / 0,049911
      PMS1 1,8236 7,3582 >0.05 / 0,039034
      RAD50 2,6223 10,2765 >0.05 / 0,03758
      RAD51 2,6223 10,2765 >0.05 / >0.05
      RAD51B 4,3683 16,7622 >0.05 / >0.05
      RAD51D 3,2769 7,0688 >0.05 / >0.05
      RAD52 2,0126 5,1099 >0.05 / >0.05
      RPA3 2,8581 7,9353 >0.05 / >0.05
      PRKDC 0,5309 2,9778 >0.05 / >0.05
      SMUG1 6,7053 18,0914 >0.05 / >0.05
      TREX1 0,5115 4,1669 >0.05 / >0.05
      UNG 7,422 26,6752 0,027669 / 0,009662
      XPA 2,0485 8,8342 >0.05 / >0.05
      XRCC2 5,6758 17,6367 >0.05 / >0.05
      XRCC4 5,9765 17,0836 >0.05 / >0.05
      Table 2: The genes that fold change values ​​were statistically significant (p <0.05) in MPM and adenocarcinoma tumor cells relative to each other
      Gene MPM / Adenocarcinoma fold change P
      CDK7 4.39 <0.05
      MLH1 5.32 <0.05
      TREX1 9.29 <0.05
      PRKDC 7.64 <0.05
      XPA 5.54 <0.05
      PMS1 5.19 <0.05
      UNG 4.93 <0.05
      RPA3 2.97 <0.05

      Conclusion
      We showed that adenocarcinoma and MPM tumor cells have different expression profiles of DNA repair genes. Our study suggests that TREX1, PRKDC, PMS1 genes can be significant in support of differential diagnosis between MPM and lung adenocarcinoma.

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    P1.12 - Poster Session 1 - NSCLC Early Stage (ID 203)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P1.12-004 - Accuracy of PET/CT in the Evaluation of N1 and N2 Lymph Node Stations in Operable NSCLC (ID 1181)

      09:30 - 16:30  |  Author(s): A. Akkoclu

      • Abstract

      Background
      Aim: Mediastinal lymph node metastases are frequent in non small cell carcinomas (NSCLC). We aimed to investigate the diagnostic accuracy of PET-CT for different mediastinal lymph nodes in operable NSCLC patients by comparing PET-CT results with cervical mediastinoscopy and thoracotomy findings.

      Methods
      Methods: Medical records of 124 operable NSCLC patients to whom PET-CT was applied for clinical staging between November 2009 and December 2011 were evaluated retrospectively. PET-CT was negative in 64 of 124 patients. Thirty-four of the patients underwent cervical mediastinoscopy, 4 underwent anterior mediastinotomy, 3 underwent thoracotomy and the remaining 83 were operated without any prior invasive procedure. PET/CT uptake of different stations were explored, sensitivity, specifity, negative (NPV) and positive predictive (PPV) values and accuracy rates were calculated

      Results
      Results: Sensitivity, specifity, PPV, NPV and accuracy rates for N1 and N2 lymph nodes are shown in the table. Accuracy rates were low for 4th, 7th and 10th numbered lymph nodes. However any significant correlation was not observed between pathology and PET-CT for nodal stations 3 and 10.

      % Sensitivity Specifity PPV NPV Accuracy
      N1 8 94 21 82 78
      N2 57 93 49 95 89

      Conclusion
      Conclusion: The lower rates of PET-CT sensitivity and PPV for N1 lymph nodes than N2 lymph nodes reflect the poor success rates of N1 determination with PET-CT. The lower accuracy rates of 4, 7 and 10 station lymph nodes with PET-CT as well as the pathology and PET-CT uncorrelation for 3 and 10 lymph nodes might be explained by the close localization of these stations to N1 lymph nodes and the restriction of the PET-CT in discrimination of N2 lymph nodes from N1 in this area.

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    P1.21 - Poster Session 1 - Diagnosis and Staging (ID 169)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Prevention & Epidemiology
    • Presentations: 1
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      P1.21-006 - Diagnostic value of CT fluoroscopy-guided transbronchial biopsy in endobronchially invisible and transthorasically inaccessible nodule/mass of the lung (ID 2408)

      09:30 - 16:30  |  Author(s): A. Akkoclu

      • Abstract

      Background
      To evaluate the usefulness of transbronchial needle biopsy (TBNB) under computed tomography fluoroscopy (CTF) for pulmonary nodule/mass that is invisible at bronchoscopy and not suitable for biopsy using transthoracic approach.

      Methods
      The study included 23 patients (14 men, 9 women and mean age of 57 years) with pulmonary mass/nodule on computed tomography (CT) scans. In all patients, there was no an endoluminal lesion at bronchoscopy previously carried out and transthoracic biopsy was considered to be inappropriate owing to location of the lesion and/or presence of serious emphysema with abnormal pulmonary function test result. The procedure was done in a CT room with a monitor faced to the radiologist, while performing the broncoscopy by a bronchoscopist. CT fluoroscopic real-time scans were used to confirme that the tip of the bronchoscopic needle was exactly inside of the pulmonary target lesion. After the biopsy performed under CTF guidance, the obtaining samples were examined histopathologically.

      Results
      Figure 1 CTF-guided transbronchial biopsy samples were adequate for definitive diagnosis in 19 (83%) patients and inadequate in 4 (17%) patients. Inadequate results were caused by inability to reach the lesion as seen on CTF scans. 15 nodules/masses were diagnosed as malignant, 4 as benign. For malignant lesions, the final diagnoses were adenocarcinoma (n=5), small cell lung cancer (NSCLC) (n=4), non-NSCLC of undetermined cell type(n=2), epidermoid carcinoma (n=2), lymphoma (n=1) and sarcoma (n=1). Among the benign lesions, specific diagnoses were obtained in 2 (%50) patients. Mild to moderate hemoptysis occurred in 4 (17%) patients.

      Conclusion
      CT fluoroscopy-guided transbronchial biopsy is an effective and safe method to obtain the diagnosis of the lung lesion. It seems to be particularly valuable with a real-time guidance in pulmonary nodule/mass which is invisible at bronchoscopy and inappropriate for transthoracic biopsy.

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    P2.12 - Poster Session 2 - NSCLC Early Stage (ID 205)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 2
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      P2.12-007 - PET/CT Findings of Adenocarcinoma Patients (ID 1175)

      09:30 - 16:30  |  Author(s): A. Akkoclu

      • Abstract

      Background
      AIM: New classification of adenocarcinoma subtypes cannot be discriminated by PET/CT findings. The aim of this study was to evaluate the features of operable adenocarcinoma patients according to PET/CT findings.

      Methods
      METHODS: Medical records of 49 adenocarcinoma patients to whom PET-CT was applied for clinical staging between November 2009 and December 2011 were evaluated retrospectively.

      Results
      RESULTS: Mean tumor size was 3,51±1,70 and mean tumor SUV max value was 8,18±4,50. Tumor size and tumor SUV max values were not different between subtypes. Seventeen of the patients had positive and 8 had suspicious positive mediastinal lymph nodes, however only 16 of the positive N2 lymph nodes were determined to be pathologically positive by mediastinoscopy or thoracotomy. Tumor SUV max values were found to be correlated with tumor size (r=0,493, p<0,001). The most frequent subtype was unclassified (32 patients). The others were mixed (6), acinar (4), lepidic (3), mucinous (2), solid (1) and papillary (1) subtypes.

      Conclusion
      CONCLUSION: We need studies involving more patients to evaluate the differences between PET/CT uptakes of adenocarcinoma subtypes, although we observed an association with tumor size and SUV max values of the adenocarcinomas regardless from the histopathological subtypes.

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      P2.12-008 - Do PET/CT Findings Predict Clinical Staging in NSCLC ? (ID 1183)

      09:30 - 16:30  |  Author(s): A. Akkoclu

      • Abstract

      Background
      AIM: Staging of lung cancer determines the choice for treatment. Currently, PET/CT has been used widely in the staging NCSLC. We aimed to investigate the changes in clinical staging of NSCLC patients after PET/CT procedure.

      Methods
      METHODS: Clinical and pathological data of 124 operable NSCLC patients to whom PET-CT was applied for clinical staging between November 2009 and December 2011 were evaluated retrospectively. PET-CT was positive for N2 lymph nodes in 60 of 124 patients. Thirty of them underwent mediastinoscopy, 4 underwent mediastinotomy and 2 underwent thoracotomy and the remaining 24 were operated without any prior invasive procedure for the evaluation of mediastinal lymph nodes. Among the 64 PET/CT negative patients 59 were directly operated, 4 underwent mediastinoscopy and 1 to thoracotomy.

      Results
      RESULTS: Stage 3A was the most frequent stage in both clinical and pathological staging. T staging was the same for both clinical and pathological stages in 48%of the patients, while this was 58% for mediastinal lymph nodes. Overall clinical and pathological stages were the same in 42% of the patients, while in 34% clinical staging was lower and in 24% higher than the pathological staging. The most compliant stage between clinical and pathological stages was 1A while the least one was stage 1B.

      Conclusion
      CONCLUSION: Clinical staging with the assistance of PET/CT was observed to be moderate compliant with pathological staging in most of the patients. Therefore, clinical staging with PET/CT should not replace pathological staging in NSCLC

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    P3.12 - Poster Session 3 - NSCLC Early Stage (ID 206)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P3.12-003 - Preoperative Management of NSCLC Patients With PET/CT N2 Positive Mediastinal Lymph Nodes (ID 1179)

      09:30 - 16:30  |  Author(s): A. Akkoclu

      • Abstract

      Background
      AIM: PET/CT has been widely used in the diagnosis and management of lung cancer patients. We aimed to investigate the progress of N2 positive NSCLC patients after PET-CT examinations.

      Methods
      METHODS: Clinical and pathological data of 124 operable NSCLC patients to whom PET-CT was applied for clinical staging between November 2009 and December 2011 were evaluated retrospectively.

      Results
      RESULTS: PET-CT was positive for N2 disease in 60 patients. Among them 24 were operated without any prior invasive procedure, while the remaining was investigated with different procedures for mediastinal lymph node involvement. Thirty of them had cervical mediastinoscopy, 4 had anterior mediastinotomy and 2 had thoracotomy. N2 positivity determined in nodal stations 5 and 7 was also corrected with thoracotomy. However, N2 involvement was not observed in one patient who underwent anterior mediastinotomy and 13 patients who underwent cervical mediastinoscopy, although they had positive PET/CT results. The overall true positivity within these patients who underwent preoperative diagnostic procedures for N2 lymph nodes was 22 out of 36 patients (61%). N2 lymph node involvement was observed in 6 of the 24 patients who were directly operated (25%).

      Conclusion
      CONCLUSION: Although PET/CT had an important contribution in the preoperative management of NSCLC patients, histopathological confirmation remains the golden standard for operable cases.

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    P3.24 - Poster Session 3 - Supportive Care (ID 160)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P3.24-050 - Multiple Distant Metastases In A Case Of Malignant Pleural Mesotelioma (ID 3279)

      09:30 - 16:30  |  Author(s): A. Akkoclu

      • Abstract

      Background
      Distant metastases of MPM to the skeletal muscle, endocardium and skin have not been reported previously.

      Methods
      A 75 year-old male admitted to our pulmonary diseases clinic with chest and lower limb pain. He was a heavy smoker and exposed to asbestos in his childhood. Respiratory system was normal in physical examination. The thigh muscles were observed to be thick and hard and palpation was painful. There were few nodular lesions on the scalp which he reported to appear 2 months ago as well as the accompanying femoral thickening.

      Results
      Chest X-ray showed upper mediastinal enlargement and a mass in left superior lobe. Thorax CT revealed a pleural mass in the left apical region, left hilar lymphadenopathy and pleural thickening. Pathological FDG uptakes were observed over the right paraspinal muscle (C6), posterior scalp, paratracheal and left hilar lymp nodes, left apical mass, left pleura in lower and middle zone, left diaphragma, anterior pericardium, interventricular septum, left axilla, right 4. costochondral region, liver segment 8, right paraspinal muscle in L3 level, right abdominal oblic muscles, bilateral gluteal muscles and bilateral muscles in femoral region. Tru-cut biopsy was performed from the left apical mass and the diagnose was epitheloid type malignant pleural mesothelioma. A second biopsy was performed from anterior thigh muscles. The morphologic pattern was the same with the biopsy taken from lungs

      Conclusion
      Metastases of a MPM are very rare. We are presenting this case for the skeletal muscle metastasis defined for the first time.