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P. Lee

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    MTE 05 - Role of the Interventional Pulmonologist and Medical Pleuroscopy (Ticketed Session) (ID 57)

    • Event: WCLC 2015
    • Type: Meet the Expert (Ticketed Session)
    • Track: Treatment of Localized Disease - NSCLC
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/07/2015, 07:00 - 08:00, 111
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      MTE05.01 - Role of the Interventional Pulmonologist and Medical Pleuroscopy (ID 1984)

      07:00 - 08:00  |  Author(s): P. Lee

      • Abstract
      • Presentation
      • Slides

      Bronchoscopy dates back to the late 18th century where rigid illuminating tubes were used to examine the tracheobronchial tree. With the introduction of the fiberoptic bronchoscope, bronchoscopy has revolutionized the practice of pulmonary medicine. In lung cancer, due to advances in real-time imaging and catheter based techniques, bronchoscopy remains pivotal not only in diagnosis and staging, it also allows therapeutic intervention for airway restoration in patients with central airway obstruction, and treatment of early detected central airway cancers. For peripheral lung nodules that are beyond the visibility of the bronchoscope, computed tomography (CT) guided, navigational methods, and endobronchial ultrasonography (EBUS) facilitate accurate targeting. Since bronchoscopy allows access to the lung, it enables researchers to better understand lung carcinogenesis, discover biomarkers for early detection and prognostication as well as assess tumor response to targeted therapy by in-vivo microdynamic imaging. Pleuroscopy provides the physician a window to the pleural space by enabling biopsy of the parietal pleura under direct visual guidance in the evaluation of effusions of unknown etiology, guided chest tube placement, and talc pleurodesis as palliation of malignant pleural effusions. Cancer related pleural effusions occur as a result of direct tumor invasion, tumor emboli to the visceral pleura with secondary seeding of the parietal pleura, hematogenous spread, or via lymphatic involvement. Elastin staining and careful examination for invasion beyond the elastic layer of the visceral pleura should be carried out for lung cancer resections, as visceral pleural invasion is regarded as an important stage-defining feature in the absence of nodal involvement. Metastatic spread of lung cancer to the pleura adversely affects survival, and in the recent TNM staging of lung cancer, presence of pleural metastasis is defined as M1a (from T4), representing a corresponding change from stage IIIB to stage IV. It is rare to find resectable lung cancer in the setting of an exudative pleural effusion, despite negative cytologic examination. Thus, pleuroscopy can establish operative eligibility by determining if the pleural effusion is paramalignant or due to metastases. If pleural metastases are found, and therefore confirming inoperable disease, talc poudrage can be performed at the same setting. This has been shown to be more effective in preventing recurrence than intrapleural instillation of a sclerosant.

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    P2.06 - Poster Session/ Screening and Early Detection (ID 219)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Screening and Early Detection
    • Presentations: 1
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      P2.06-010 - Exhaled Biomarkers for Lung Cancer Screening (ID 3179)

      09:30 - 17:00  |  Author(s): P. Lee

      • Abstract

      Lung cancer is the leading cause of global cancer death in both males and females. Figures on disease outcome are disappointing despite advances in treatment since 86% lung cancer patients die within 5 yrs of diagnosis. However with early detection and treatment, 5-year survival improves from 20% stage III to 70% stage I disease. Breath chemical tests have been applied in respiratory disorders and we sought to determine if exhaled breath volatile compounds (VOC) could discriminate patients with lung cancer from pulmonary tuberculosis (TB) by comparing them against age matched controls.

      Subjects seen at outpatient respiratory clinics with CXR suspicious of lung cancer were recruited. Diagnosis of lung cancer or TB was established via bronchoscopic, CT lung biopsy or sputum cultures and exhaled breath was collected. Patients with other lung diseases but gender and age matched were recruited as controls. Analysis of VOC was performed by Thermal Desorption-Gas Chromatography mass spectrometry (TD-GC/MS) using Unity Series 2 Thermal Desorber (Markes International Limited) and 6890 GC system (Agilent Technologies), interfaced with 5973 MSD (Agilent Technologies). Data were analyzed by MZmine 2.11 for peak alignment and normalization, and OPLS for statistical clustering analysis. Additional univariate and receiver operating characteristic analysis were performed with SPSS.

      Statistical clustering analysis OPLS Fig1 showed breath profile differences between lung cancer (n=17) and those with other lung diseases (CON, n=19). Fig2 indicated that breath profile of lung cancer patients was also different from those with Tuberculosis (TB). Specific VOC that contribute to these breath differences will be identified by TD-GC/MS. Individual breath VOC was reproducible in triplicates. Figure 1Figure 2

      These exciting preliminary results suggest that exhaled breath collected from subjects attending respiratory clinic may serve as screening test to aid the physician in the identification of patients with lung cancer and pulmonary tuberculosis from other respiratory diseases.