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J.P. Franceschini



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    P1.04 - Poster Session/ Biology, Pathology, and Molecular Testing (ID 233)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Biology, Pathology, and Molecular Testing
    • Presentations: 1
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      P1.04-040 - Stage I Adenocarcinoma According to the 2011 IASLC/ ATS/ ERS: Case Series from Brazil (ID 3145)

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

      • Abstract

      Background:
      Lung cancer is the deadliest cancer worldwide and it is of particular concern in Brazil as the second cause of cancer death in both genders. The new classification proposed by International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society Classification has proven its prognostic value with also a better clinical understanding of lung adenocarcinoma. Prior to this classification all patients diagnosed with early stage adenocarcinoma were considered to have practically the same disease. In our country, however, medical literature is still incipient on this topic. We reviewed the histopathology of a consecutive series of patients diagnosed with stage I adenocarcinoma.

      Methods:
      Cross-sectional study including 50 patients diagnosed with stages IA or IB adenocarcinoma undergoing surgical resection of non-small cell lung cancer. The variables: histological subtype, sex, age and tumour size. We have divided patients in two groups based on the presence of lepidic features. Statistical analysis was performed by Anova and Bonferroni multiple comparison test, to correlate tumour size among histological subtype groups.

      Results:
      The mean age was 63.7 (11.5) years, 50% were men. The average size of resected tumours was 1.4 (0.7) mm; 45 cases (90%) were stage IA. The predominant subtypes were histologically lepidic (n=24, 48%); the acinar subtype was found in 20 (40%) cases. Patients and tumour characteristics according to histological subtype are showed in table 1. There was statistical difference in size (p<0.05) when comparing lepidic tumors with acinar tumors (1.3mm versus 2.3mm respectively). Table 1: Patients and tumour characteristics according to histological subtype.

      Subtypes Variables Lepidid Acinar Others p
      n (%) 24 (48) 20 (40) 6 (12)
      Men n (%) 11 (45.8) 9 (45) 6 (100)
      Age mean (SD) 63 (11.6) 66.3 (10.8) 62.7 (7.7)
      Tumor size mean (SD) 1.3 (0.6) 2.3 (1.4) 1.6 (0.6) 0.02*
      *Anova with Bonferroni multiple comparison test.

      Conclusion:
      In our brief series of lung adenocarcinoma patients, the most common subtypes were acinar and lepidic; the latter being larger in this sample. The long-term follow-up will give us important information about the prognosis of these patients treated exclusively with surgery.

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    P1.06 - Poster Session/ Screening and Early Detection (ID 218)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Screening and Early Detection
    • Presentations: 1
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      P1.06-021 - Is Safe to Follow High-Risk Patients with Suspicious Lung Nodules without Invasive Tests? (ID 3182)

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

      • Abstract

      Background:
      Low dose computed tomography (LDCT) screening for lung cancer (LC) provides reduction in mortality rates among individuals at high risk. Pre-Test Probability of Malignancy (PTPM) is a common tool used during the decision process: when the probability of malignancy is moderate or high, patients should be referred for further testing or tissue sampling. However, in some cases, these statistic models may give an overestimated value, especially in countries with a high incidence of granulomatous diseases. We have calculated the PTPM in our LDCT screening program and this work explores its main results.

      Methods:
      Prospective cohort of current or former smokers, with a heavy smoking history. Data of the first LDCT were analyzed to calculate the PTPM. The inclusion criteria were similar to NLST. LDCT scans with indeterminate pulmonary nodules above 4mm in size were considered positive and were evaluated by a multidisciplinary team. The PTPM model used in this study was designed by Swensen et al and included patient’s age, smoking history, diameter of the nodule, spiculation and upper lobe location. A PTPM > 60% was considered high and between 6 and 60% was considered moderate.

      Results:
      From January 2013 to July 2014, 790 were included in the protocol. We found 310 positive LDCT at baseline (39%), 34 (11%) with high PTPM. Among them, 16 were followed with LDCT in 3 (56.2%), 6 (37.5%) or 12 (6.3%) months and the remaining were investigated with PET-CT and/or lung biopsy. From the patients followed by LDCT, one case showed an increase in nodule size and was investigated with lung biopsy; all others were stable in one-year follow up. LC was diagnosed in 7 patients and benign diseases in 5 patients with high PTPM, including 1 case of tuberculosis. Other 4 cases of NSCLC were found in the moderate PTPM group (n=272). Therefore, malignancy rate was 20.6% for high PTPM and 1.5% for moderate PTPM nodules.

      Conclusion:
      The Swensen’s PTPM model overestimates the prevalence of LC in both groups of moderate and high-calculated values of PTPM. The decision making process should include other variables discussed in a multidisciplinary board, been safe to follow patients with further image tests.