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H. Prosch
Moderator of
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IA04 - Interactive Session Target Delineation: Group I (Ticketed Session) (ID 290)
- Event: WCLC 2016
- Type: Interactive Session
- Track: Radiotherapy
- Presentations: 1
- Moderators:K. Dieckmann, H. Prosch
- Coordinates: 12/05/2016, 16:00 - 17:30, Schubert 3
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IA04.01 - Interactive Session Target Delineation (ID 6521)
16:00 - 17:30 | Author(s): C. Faivre-Finn, L. Gaspar, B. Loo
- Abstract
- Presentation
Abstract not provided
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IA06 - Interactive Session Staging Group II (Ticketed Session) (ID 292)
- Event: WCLC 2016
- Type: Interactive Session
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:K. Dieckmann, H. Prosch
- Coordinates: 12/06/2016, 11:00 - 12:30, Schubert 3
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IA06.01 - Interactive Session Staging (ID 6520)
11:00 - 12:30 | Author(s): E. Stiefsohn, L. Havel, A. Kerpel-Fronius
- Abstract
Abstract not provided
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IA07 - Interactive Session Target Delineation: Group II (Ticketed Session) (ID 293)
- Event: WCLC 2016
- Type: Interactive Session
- Track: Radiotherapy
- Presentations: 1
- Moderators:K. Dieckmann, H. Prosch
- Coordinates: 12/06/2016, 16:00 - 17:30, Schubert 3
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IA07.01 - Interactive Session Target Delineation (ID 6522)
16:00 - 17:30 | Author(s): C. Faivre-Finn, B. Loo
- Abstract
- Presentation
Abstract not provided
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PC01 - Pro Con Session: Invasive Mediastinal Staging for N2 Disease (ID 323)
- Event: WCLC 2016
- Type: Pro Con
- Track: Radiology/Staging/Screening
- Presentations: 4
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PC01.01 - Introduction & Vote (ID 6872)
14:30 - 15:45 | Author(s): H. Prosch
- Abstract
Abstract not provided
Information from this presentation has been removed upon request of the author.
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PC01.02 - Invasive Staging and Restaging (ID 6594)
14:30 - 15:45 | Author(s): C. Dooms
- Abstract
- Presentation
Abstract:
The aim of mediastinal staging is to exclude with the highest certainty and the lowest morbidity patients with mediastinal nodal disease. The concepts of decision analysis and Bayes’ theorem form the basis for a mediastinal staging strategy. The goal of the clinical staging strategy is to lower the post-test probability sufficiently so that it falls below a testing threshold, which ascertains the clinician that the result is accurate. The ESTS working group considers a rate of unforeseen mediastinal nodal disease at the time of anatomic resection with lymph node dissection less than 10% as acceptable.[1] Contrast-enhanced multi-detector CT (computed tomography) scanning has an excellent spatial resolution but is an imperfect means of staging the mediastinum. A Cochrane review evaluated integrated positron emission tomography (PET) - CT for assessing mediastinal lymph node involvement in NSCLC.[2] The review showed that the accuracy of PET-CT is insufficient to allow management on PET-CT alone, but PET-CT can be used to guide clinicians in the next step (either a biopsy or direct to surgery). The suboptimal specificity of mediastinal lymph nodes positive on PET-CT requires a tissue confirmation. There are conditions where invasive staging is also mandatory despite a normal mediastinum on PET-CT as the prevalence of N2/N3 disease remains significant. These conditions include a primary tumour >3 cm, any central primary tumour, PET/CT hilar N1 disease, or low FDG uptake in the primary tumour.[1] Cervical Mediastinoscopy. A conventional cervical mediastinoscopy through a pretracheal suprasternal incision was introduced in 1959 and for decades considered the gold standard for invasive mediastinal nodal staging. Recently, a very large (N=721 patients; prevalence of mediastinal nodal disease 47 %) retrospective single center study reported on safety and efficacy of cervical mediastinoscopy performed by general thoracic surgeons.[3] There was no mortality, a low perioperative complication rate at 1.3 %, and an unexpected hospital (re)admission rate of 0.46 %. The sensitivity, negative predictive value and post-test probability were 0.90 (95% CI 0.87-0.92), 0.92 (95% CI 0.90-0.94), and 0.09 (95% CI 0.07-0.11), respectively. It is performed under general anesthesia and allows a full mapping of the ipsilateral and contralateral superior mediastinal lymph nodes. Since 1995, the use of video techniques has been introduced leading to video-assisted mediastinoscopy (VAM) clearly improving visualization and teaching. In addition, VAM allows bimanual dissection with possibilities to perform nodal dissection and removal rather than sampling or biopsy. The ESTS working group recommends performing VAM.[1] Endoscopic ultrasonography (EUS) en endobronchial ultrasonography (EBUS). In the last decade, the predominant role of cervical mediastinoscopy has been challenged by EUS and EBUS using a convex probe. When mediastinal nodal staging is required, systematic nodal sampling seems feasible but some primary choices have to be made. At least mediastinal nodal stations 4R, 4L and 7 should be sought. To avoid contamination, the order of sampling should begin at the level of N3 stations followed by N2 stations before N1. There is no evidence to suggest that sampling of all visible nodes in each nodal station is superior to a systematic nodal sampling of the largest measuring ≥5 mm or PET-positive node in each station. It must be stressed that EBUS cannot access the prevascular nodes (station 3a), the subaortic and para-aortic nodes (stations 5 and 6) as well as the paraesophageal and pulmonary ligament nodes (stations 8 and 9). Some of these nodes (stations 8 and 9) can however be reached from the esophagus. Therefore the use of the EBUS scope is extended to an esophageal exploration with EUS-B sampling of stations 4L, 7, 8 and 9. In terms of safety, EBUS and EUS have a low complication or serious adverse event rate of 1.4 and 0.3%, respectively.[4,5] The two staging strategies, surgical staging alone on the one hand and combined EUS/EBUS followed by surgical staging whenever endosonography was negative on the other hand, were compared in a pivotal randomized controlled trial (RCT).[6] It was concluded that invasive mediastinal nodal staging should start with combined linear endosonography, as the trial showed that a staging strategy starting with combined linear endosonography (EUS+EBUS) detected significantly (P=0.02) more mediastinal nodal N2/N3 disease compared to cervical mediastinoscopy alone, resulting in a significantly higher sensitivity of 0.94 (95%CI 0.85-0.98) compared to 0.79 (95%CI 0.66-0.88), respectively.[6] Another RCT suggested that EBUS-TBNA is the preferred primary procedure in combined linear endosonography for mediastinal nodal staging of resectable stage I-III lung cancer.[7] There is no RCT comparing combined EBUS-EUS(-B) to EBUS-TBNA alone for mediastinal nodal staging, but a recent meta-analysis suggested that the combined EBUS-EUS is more sensitive than EBUS-TBNA alone to detect mediastinal nodal disease.[8] The absolute increase in sensitivity of the combined approach compared to EBUS-TBNA alone depends on the quality of the EBUS-TBNA procedure, but published studies suggest an increase in sensitivity up to 10%. Overall, a confirmatory VAM is still warranted for the individual patient with a negative combined linear endosonography as this further lowers the post-test probability. This has been shown within ASTER for patients with clinical N2/3 disease on PET-CT (prevalence of mediastinal nodal disease 63%), as the post-test probability of a negative linear combined endosonography of 20% could be lowered to 5% by adding a cervical mediastinoscopy.[9] A recent prospective cohort study on clinical stage II lung cancer based on N1 disease on imaging (prevalence of mediastinal nodal disease 24%) showed that the post-test probability of a negative endosonography was 19%, which could be lowered to 9% by adding a cervical mediastinoscopy.[10] In conclusion, combined EBUS-EUS(-B) linear endosonography is the standard for initial baseline mediastinal nodal staging, but a VAM is still recommended after a negative (or incomplete) combined linear endosonography. Mediastinal restaging after induction therapy for locally advanced stage III NSCLC is an important prognostic factor. In the context of a 40-50% prevalence of residual mediastinal disease after induction therapy, a first cervical VAM as a restaging technique seems to be the most accurate method for nodal assessment.[1] Overall, limited literature reported a sensitivity and NPV for linear endosonography that is lower than for a first mediastinoscopy.
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PC01.03 - No Invasive Staging Nor Restaging (ID 6595)
14:30 - 15:45 | Author(s): E. Lim
- Abstract
- Presentation
Abstract not provided
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PC01.04 - Discussion & Vote (ID 6873)
14:30 - 15:45 | Author(s): W. Weder
- Abstract
- Presentation
Abstract not provided
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WS03 - IASLC Meets ESTI: Imaging in Lung Cancer Staging and Diagnosis (ID 361)
- Event: WCLC 2016
- Type: Workshop
- Track: Radiology/Staging/Screening
- Presentations: 4
- Moderators:H. Prosch, R. Rami-Porta
- Coordinates: 12/04/2016, 08:00 - 11:45, Strauss 2
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WS03.01 - T Stage (ID 6765)
08:00 - 11:45 | Author(s): H. Prosch
- Abstract
- Presentation
Abstract not provided
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WS03.02 - N Stage (ID 6767)
08:00 - 11:45 | Author(s): C. Schäfer-Prokop
- Abstract
- Presentation
Abstract not provided
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WS03.03 - M Stage (ID 6768)
08:00 - 11:45 | Author(s): N. Sverzellati
- Abstract
- Presentation
Abstract not provided
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WS03.04 - Ultrasound- and CT-Guided Biopsies for the Diagnosis of Lung Cancer (ID 6766)
08:00 - 11:45 | Author(s): G. Mostbeck
- Abstract
- Presentation
Abstract not provided
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Author of
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PC01 - Pro Con Session: Invasive Mediastinal Staging for N2 Disease (ID 323)
- Event: WCLC 2016
- Type: Pro Con
- Track: Radiology/Staging/Screening
- Presentations: 1
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SC16 - Superior Sulcus Tumors (ID 340)
- Event: WCLC 2016
- Type: Science Session
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:D. Jones, W. Klepetko
- Coordinates: 12/06/2016, 14:30 - 15:45, Lehar 1-2
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SC16.01 - Imaging Techniques for Staging and Restaging of Superior Sulcus Tumors (ID 6663)
14:30 - 15:45 | Author(s): H. Prosch
- Abstract
Abstract not provided
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WS03 - IASLC Meets ESTI: Imaging in Lung Cancer Staging and Diagnosis (ID 361)
- Event: WCLC 2016
- Type: Workshop
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:H. Prosch, R. Rami-Porta
- Coordinates: 12/04/2016, 08:00 - 11:45, Strauss 2
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WS03.01 - T Stage (ID 6765)
08:00 - 11:45 | Author(s): H. Prosch
- Abstract
- Presentation
Abstract not provided
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