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R. Bowman



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    P1.23 - Poster Session 1 - Tobacco Control, Prevention and Chemoprevention (ID 162)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Prevention & Epidemiology
    • Presentations: 1
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      P1.23-002 - A randomized controlled trial of brief counselling intervention and audio materials for smoking cessation in a low-dose CT screening study (ID 2959)

      09:30 - 16:30  |  Author(s): R. Bowman

      • Abstract

      Background
      Smoking cessation is a highly cost-effective health intervention. Embedding a smoking cessation program within a lung cancer screening program may significantly enhance the cost-effectiveness of screening. Smokers enrolling in Low-dose CT screening studies are motivated to quit but the best strategy to aid smoking cessation is not yet defined.

      Methods
      Population: smokers enrolled in a LDCT screening study, age 60-74years, with >=30 pack-year smoking history. Smokers could enrol at any time during the LDCT study. Intervention: single face-to-face counselling session on the day of attendance for LDCT screening plus audio cessation advice (on mp3 player) plus written quit materials. The individualised counselling session was given by a thoracic physician using motivational interview techniques. Control: written quit materials only. Outcome: point prevalence self-reported smoking cessation at 1 year, confirmed with exhaled CO measurement (ECO) where available; ≥10ppm level indicating non-abstinence.

      Results
      Fifty-four participants were randomized (control group n=26, intervention group n=28). There were no statistically significant differences between groups in age, sex, pack-years smoking, baseline CT scan findings, nicotine dependence score, self-belief in ability to quit (on a scale of 1-5, higher score indicating stronger belief) or education level although the intervention group reported a higher number of cigarettes smoked per day (table 1). Baseline LDCT scans were reported as positive if one or more non-calcified nodules >=4mm diameter were detected. The mean duration of interview was 26 minutes. Overall, ten participants (18.6%) reported smoking cessation (five had ECO confirmation and five did not have ECO testing); two patients (3.7%, one from each group) had missing data and were assumed to be continuing smokers; the remainder reported continued smoking. There was no difference in self-reported cessation between the intervention and control groups (17.8% vs 19.2% respectively).

      Table 1
      Control Intervention p value
      Women 10 10 ns
      Men 16 18 ns
      Education Up to High School 13 13 ns
      Teriary 13 15 ns
      Age, years, mean 64 64 ns
      Age started smoking, years 16 17 ns
      Cigarette consumption per day, n 23 30 0.03
      Pack years smoking, mean 61 64 ns
      FEV1 % predicted, mean 92 90 ns
      Fagerstrom nicotine dependence score, mean 4.9 5.2 ns
      Baseline CT Scan report Negative 12 10 ns
      Positive 14 18 ns
      Self-belief in ability to quit 3.7 3.4 ns

      Conclusion
      The 18% quit rate in this study is higher than reported background rates however the brief intervention provided did not increase quit rates above that of the control group. Smokers in this study reported moderate to high levels of nicotine dependence with extensive smoking histories, and, although motivated to quit, may require more intensive assistance to support smoking cessation.

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    P2.19 - Poster Session 2 - Imaging (ID 180)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Imaging, Staging & Screening
    • Presentations: 1
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      P2.19-007 - Pulmonary Nodule Detection by Junior Medical Staff is Improved by Digital Tomosynthesis Compared to Chest X-Ray (ID 1110)

      09:30 - 16:30  |  Author(s): R. Bowman

      • Abstract

      Background
      Junior doctors may fail to detect subtle pulmonary pathology on plain chest X-ray (CXR). Digital tomosynthesis (DT) is an emerging radiographic technique that provides multiple coronal chest images at only 2% of the radiation of a standard chest CT. Previous studies have demonstrated that pulmonary nodule detection sensitivity is three times greater with DT compared to CXR. We investigated whether DT can increase nodule detection rates by junior doctors compared to CXR.

      Methods
      Ten volunteer junior doctors (post-graduate years 1-3) at The Prince Charles Hospital in Brisbane, Australia, a secondary and tertiary referral hospital, were recruited to view CXR and DT images of 11 patients. All patients had CXR, DT and CT images acquired within a 30 day period for the evaluation of lung nodules. CT images (Philips Brilliance, Philips Medical Systems, Best, Netherlands), with collimation 0.625 mm and reconstructed slice width 0.9 mm, reported by experienced radiologists, served as the gold standard. DT images, consisting of 60 exposures through a 30° arc, were acquired using the GE Definium 8000 Xray Unit (GE Healthcare, Little Chalfont, United Kingdom), with simultaneous CXR as a scout image. Nine of these patients had at least one nodule >10 mm on CT, with two control patients without nodules. All participants undertook brief training to familiarise them with DT images one week prior to the study. In the study session, participants were showed anonymised CXR and DT images in random order and asked to mark “definite” or “possible” pulmonary nodules electronically. The markings were compared to CT detected “true” nodules. Markings made where there were no true nodules on CT were recorded as false positives. The time taken to view each image was measured. Participants completed a brief survey after viewing the images.

      Results
      Nodule detection sensitivity, represented by the proportion of true nodules marked “definitely” present, was significantly higher using DT than CXR (28/65 [43%] versus 3/70 [4%], χ[2], p<0.001), as was the proportion of nodules marked either “definitely” or “possibly” present (32/65 [49%] versus 13/70 [19%], χ[2], p<0.001). When considering instances where a nodule was marked either “definitely” or “possibly” present, where there was no true nodule on CT, significantly fewer false positives were made, on average, when viewing DT compared to CXR (0.36 versus 1.18 false positives per image, t-test, p<0.001). Although the time taken to view each DT image was statistically significantly longer than for each CXR image (86.9 seconds versus 67.9 seconds, t-test, p<0.01), the absolute difference was small. Ninety percent of participants agreed that they could identify nodules more confidently with DT than CXR.

      Conclusion
      In this study, junior doctors correctly identified more pulmonary nodules using DT compared to CXR and reported fewer false positive results. The time taken to view DT images was slightly longer than for CXR images, but this difference was small. Despite the small sample size, this pilot experiment has shown that DT may potentially improve identification of pulmonary nodules by junior doctors and a larger study is underway.

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    P3.17 - Poster Session 3 - Bronchoscopy, Endoscopy (ID 185)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track:
    • Presentations: 1
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      P3.17-008 - Electromagnetic Navigation Bronchoscopy increases diagnostic yield after non-diagnostic Endobronchial Ultrasound Guide Sheath for peripheral pulmonary lesions (ID 3226)

      09:30 - 16:30  |  Author(s): R. Bowman

      • Abstract

      Background
      Peripheral pulmonary lesions (PPLs) are diagnostic challenges. Computed tomography guided transthoracic needle aspiration (CT TTNA) has high diagnostic sensitivity but also high complication rates[1]. Endobronchial ultrasound guide sheath (EBUS GS) allows confirmation of target localisation but cannot provide guidance to the target. Electromagnetic navigation bronchoscopy (ENB) allows the bronchoscopist to navigate to target without direct vision. We assessed whether ENB could diagnose PPLs that had undergone a non-diagnostic EBUS GS.

      Methods
      We performed 50 ENB procedures for diagnosis of PPLs between 3/2011-6/2013, 15 after non-diagnostic EBUS GS. ENB data was prospectively collected. ENB (superDimension, Minneapolis, US) was performed through a standard 5.9mm bronchoscope under general anaesthesia through a laryngeal mask airway after pathway planning using iLogic software. Once the locatable guide was close to and correctly aligned with the target, it was removed and replaced by EBUS radial probe (EBUS RP) to confirm target localisation. Samples were then taken with forceps biopsy, cytology brush, and mini bronchoalveolar lavage. If ENB was non-diagnostic patients underwent further investigation. Benign diagnoses were followed up for a minimum of 6 months to ensure a consistent clinical course. Primary outcome was diagnostic yield, procedure time, and complications. Characteristics distinguishing diagnostic from non-diagnostic ENB were assessed using the chi-squared test.

      Results
      15 patients (mean age 66.67, 9 females, 12 current or ex smokers, mean BMI 25.16kg/m2) with 15 PPLs who underwent non-diagnostic EBUS GS proceeded onto ENB. Lesion location and characteristics were as follows: left (7), upper lobe/lower lobe=11/4, bronchus sign positive (14), soft tissue density/ground glass=14/1. Mean maximal lesion dimension was 25.64mm+/- 12.38mm and mean closest distance from pleura was 12.04mm +/- 12.18mm. Average total procedure time was 56.83 mins +/- 13.71mins with a mean of 4.53 biopsies taken per patient. All except one procedure was performed under general anaesthesia with a laryngeal mask airway. The target was reached in 12 patients. Median closest distance to target was 12.69mm +/- 7.83mm. Target localisation was confirmed on EBUS RP without any manipulation in 10 patients; a further 2 lesions could be localised with minor manipulation. ENB provided a diagnosis in 5 of 15 patients (33.33%): adenocarcinoma (2), squamous cell carcinoma (1), fungal infection (1), organising pneumonia (1). Non-diagnostic ENB underwent the following additional procedures: CT TTNA (7), repeat EBUS GS (1), and surgical biopsy (2). The following conditions were diagnosed: mycobacterial infection (1), adenocarcinoma (4), fibrosis (1), hamartoma (1), non-small cell carcinoma (1), nodular lymphoid hyperplasia (1). There were no complications. Procedural success was independent of lesion size (p=0.378), location (p=0.714), or morphology (p=0.464), but was related to confirmation on EBUS RP without manipulation (p=0.053), and the ability to view the lesion on Maximal Intensity Projection (MIP) view in 360 degrees (p=0.053).

      Conclusion
      ENB can successfully diagnose PPLs that have been non-diagnostic on EBUS GS. Lesions that can be confirmed on EBUS GS after being navigated to by ENB, as well as those that can be visualised in 360 degrees on MIP view, have a higher chance of success.