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Y.W. Sung



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    P1.19 - Poster Session 1 - Imaging (ID 179)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Imaging, Staging & Screening
    • Presentations: 1
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      P1.19-007 - Prediction of pleural adhesion during video-assisted thoracopic surgery in lung cancer patients (ID 2175)

      09:30 - 16:30  |  Author(s): Y.W. Sung

      • Abstract

      Background
      Pleural adhesions increase the risk of lung injury and lead consequent prolonged air-leak or conversion to open thoracotomy. We aimed to find the clinical or image predictor for pleural adhesion during video-assisted thoracoscopic surgery (VATS) in lung cancer patients.

      Methods
      Eighty-nine consecutive patients who underwent VATS for lung cancer were included. We retrospectively investigated operative records and clinical information including age, gender, smoking history, body mass index (BMI), forced expiratory volume in 1 second (FEV1), and forced vital capacity (FVC). Pleural adhesion was categorized into 5 grades; none, minimal, moderate (requiring adhesiolysis during VATS with 30 minute or less), severe (requiring adhesiolysis with 30 minute or longer), and very severe (near total involvement of the hemithorax). Advanced adhesion was defined as the presence of moderate or severe or very severe adhesion. Two radiologists blinded to clinical information performed visual analysis for image characteristics of chest CT in consensus. The presence of parenchymal band or calcified granuloma or pleural retraction around the tumor was determined. Severity of emphysema or interstitial fibrosis was assessed as 5 grades (none, trivial, mild, moderate, and severe). The extent of bronchiectasis or pleural thickening or pleural calcification or extrapleural fat thickening was evaluated as 3 grades (none, localized, and extensive).

      Results
      Pleural adhesion was found in 51 subjects (57.3 %) including 15 (16.9 %) minimal, 18 (20.2 %) moderate, 16 (18.0 %) severe, 2 (2.2 %) very severe adhesion. Male gender and current smoker was 66 subject (74.2 %) and 60 (67.4 %), respectively. Mean age was 64.6 ± 10.4 years-old. Mean value of FEV1 and FVC was 2.4 ± 0.6 ml (range; 0.7-3.9) and 3.4 ± 0.8 ml (range; 1.3-5.0), respectively. Tumor size was 3.1 ± 1.5 cm. Parenchymal band, calcified granuloma, pleural retraction was found in 41.6 %, 27 %, and 44.9 %, respectively. Most subjects had no (49.4 %) or minimal (23.6 %) emphysema. Mild, moderate, and severe emphysema was found in 18.0 %, 7.9 %, and 1.1 %, respectively. Most patients have no bronchiectasis (86.5 %) and no interstitial fibrosis (89.9 %). Localized and extensive bronchiectasis was found in 12.4 % and 1.1 %, respectively. Trivial and moderate interstitial fibrosis was found in 6.7 % and 3.4 %. Localized and extensive pleural thickening was found in 10.1 % and 1.1 %, respectively. Localized and extensive pleural calcification was found in 4.5 % and 1.1 %, respectively. Both localized and extensive extrapleural fat thickening was found in 5.6 %. In univariate analysis, male gender (P = 0.013), age (P = 0.21), FEV1 (P < 0.001), tumor size (P = 0.003) were significant predictors of advanced adhesion. Among the image characteristics, severity of emphysema was a significant predictor of advanced adhesion in univarite analysis (coeffient of 1.83, P = 0.007). Multivariate analysis revealed that independent predictor for advanced pleural adhesion was only FEV1 (coefficient of 0.13, P < 0.001).

      Conclusion
      Severity of emphysema and FEV1 might enhance the prediction of pleural adhesion during VATS in lung cancer patients.

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    P3.18 - Poster Session 3 - Pathology (ID 177)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Pathology
    • Presentations: 1
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      P3.18-016 - The usefulness of frozen section diagnosis as for the decision making milestone during the surgery for pulmonary ground glass nodules: embedding medium inflation technique (ID 2946)

      09:30 - 16:30  |  Author(s): Y.W. Sung

      • Abstract

      Background
      The appropriate intraoperative decision making of surgical resection for the pulmonary ground glass nodules (GGN) is often difficult. We aimed to evaluate the role of frozen section diagnosis (FSD) as for the intraoperative decision making milestone and compared its accuracy to that of preoperative CT based practice as an interim result.

      Methods
      We retrospectively reviewed FSD of 171 consecutive pulmonary GGN from February 2005 to June 2013 and compared the diagnostic accuracy. Initially, we used only conventional method (Group A) but recently, we adapted a embedding medium inflation method (Group B) for FSD. The qualities of FSD were compared with the final pathologic diagnoses of corresponding permanent paraffin sections. Also, we calculated the sensitivity, specificity, and predictive values of assessing the size of invasive portion in GGN between FSD using the inflation method and preoperative CT based practice.

      Results
      There were no differences in nodule sizes between two groups (1.45±0.6 versus 1.51±0.5, p=0.63). In group A, a correct differential diagnosis between malignancies and benign lesions were made in 138 nodules. Thirteen nodules were erroneously classified and reported as false-positive or false-negative frozen section diagnoses (Sensitivity 95.6%, Specificity 53.8%). Three nodules were under-diagnosed in FSD. One patient required a secondary operation because of false-negative frozen diagnosis at the time of initial surgery. In group B, all of 17 nodules were correctly classified by frozen section. There were no false-positive or false-negative diagnoses in terms of making a diagnosis of malignancy, resulting in 100%-sensitivity and -specificity. (Figure 1) Thirteen nodules were correctly classified as being either minimally invasive adenocarcinoma (MIA) or invasive adenocarcinoma. Three nodules were diagnosed as MIA by frozen section through measuring invasive tumor size (<5mm) concomitantly. With regards to the estimating the size of invasive components of GGN, FSD in group B was superior to measurement of solid component in GGO nodules on HRCT. (Table 1)Figure 1

      Conclusion
      The accuracy of FSD using the embedding medium inflation method in GGO nodules was outstanding compared to the conventional frozen method. Furthermore, this method can help surgeons plan the appropriate surgical treatment after wedge resection of a GGO nodule by providing accurate size estimation of the invasive components of the GGN.