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C.I. Henschke



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    P1.03 - Poster Session with Presenters Present (ID 455)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Radiology/Staging/Screening
    • Presentations: 2
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      P1.03-021 - Initial Results from A Novel and Low Cost Method For Measuring CT Image Quality (ID 6317)

      14:30 - 15:45  |  Author(s): C.I. Henschke

      • Abstract

      Background:
      Accurate measurement of change in tumor size in Computed Tomography images is critical for lung nodule differential diagnosis. Standard CT scanner calibration phantoms and methods are routinely relied upon to ensure that image quality is generally sufficient for a wide range of imaging tasks. However, high precision medical imaging applications, such as RECIST and volumetric tumor change measurement, require much greater attention to maintaining consistently high image quality characteristics. A new ultra-low cost, and cloud based method has been developed to quickly assess the image quality of CT scanners and imaging protocols that provides both estimates of clinical task performance, such as lung tumor size measurement error rates, and fundamental image quality performance metrics. In addition, multiple large imaging organizations have made available lung cancer screening guidance documents indicating that CT slice thicknesses of <= 1.25 mm are either required or preferred.

      Methods:
      To demonstrate the image quality site measurement capability a global challenge was launched during May and June of 2016 that allowed lung cancer screening sites to scan three rolls of 3M ¾ x 1000 inch Scotch Magic ™ Tape placed at increasing distances from iso-center on the CT table and using their standard low dose lung cancer screening protocol. Fully automated software detected the rolls of tape and estimated fundamental image quality parameters including CT linearity, 3D resolution, noise, and level of edge enhancement. In addition, metrics indicating the expected detection and volume change measurement performance for different diameter lung nodules were calculated.

      Results:
      A total of 27 clinical sites participated in the challenge and provided CT imaging data on over 54 CT scanners representing 18 scanner models made by Siemens, GE, Philips, and Toshiba. 17 out of 27 (63%) clinical sites provided data with <= 1.25mm DICOM specified slice thickness. However, only 19% of sites used <= 1.25mm slice thickness and a reconstruction kernel that avoided excessive smoothing and avoided high levels of edge enhancement.

      Conclusion:
      A new rapid, ultra-low cost, and cloud based method for assessing the quality of CT imaging studies has revealed poor adherence to recommended protocols and large levels of variation in fundamental image quality properties. Utilization of these new tools has the potential to help correct image quality issues in clinical studies.

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      P1.03-052 - The Effect of Rounding on Rate of Positive Results on CT Screening for Lung Cancer (ID 6095)

      14:30 - 15:45  |  Author(s): C.I. Henschke

      • Abstract
      • Slides

      Background:
      Effective management of small pulmonary nodules to reduce frequency of false positives has been one of the most challenging issues to implementation of screening. Measurement of size is important as it determines whether a nodule is positive result and also whether growth has occurred. Lung-RADS v.1 guideline requires nodule measurement to be rounded to the nearest whole number, it is not specified whether individual length and width measures should also be rounded prior to rounding the diameter. An alternative approach is the one used in I-ELCAP where measurements were recorded to one decimal place. This study explored how rounding would affect the frequency of positive results both for baseline and annual rounds.

      Methods:
      Using data collected from CT screenings of 21,136 I-ELCAP participants, we evaluated four different approaches for calculating the nodule diameter (D) based on measurements of the length (L) and width (W) listed below: 1) Measurement of L and W to one decimal place (x.x) and calculation of D without rounding; 2) rounding D to the nearest integer; 3) rounding the L and W measurements to the nearest integer before calculating D with no further rounding; and 4) rounding the calculated D determined by method 3 to the nearest integer. Threshold of positive results was 6.0 mm for baseline round and 4.0 mm for annual repeat rounds of screening. Frequency of positive results in the baseline and annual repeat rounds were compared.

      Results:
      For baseline screening using the current I-ELCAP definition (Method 1), the rate of positive results was 10.2%. Using method 2, 3 and 4, positive rates were 12.8%, 10.5% and 13.2%, respectively. Use of rounding would have increased the frequency of positive results by 25.7%, 3.0%, and 28.9%, respectively. Of 85,877 repeat screenings, the rate of positive results was 8.0% using method 1. Using method 2, 3 and 4, positive rates were 9.7%, 8.3% and 9.8%, respectively. Use of rounding would have increased the frequency of positive results on repeat screenings by 20.5%, 3.2%, and 22.3%, respectively.

      Conclusion:
      Regardless of where the rounding occurred, it results in more nodules designated as positive. This effect is most pronounced when the rounding occurs in average diameter, and since frequency of nodules increases as size decreases, small nodules are therefore the most frequent cause for positive results and rounding can lead to large increases in positive rates.

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    P1.05 - Poster Session with Presenters Present (ID 457)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Early Stage NSCLC
    • Presentations: 2
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      P1.05-071 - A Review of Quality of Life Measures Used in Lung Cancer Surgical Outcomes (ID 6175)

      14:30 - 15:45  |  Author(s): C.I. Henschke

      • Abstract

      Background:
      With the increased life expectancy following surgery for early stage non-small-cell lung cancer (NSCLC), concern about the quality of life (QoL) of patients after surgery has gained attention. Previous QoL studies were limited by small sample size, inclusion of late-stage cancers and non-surgical treatments. This review summarized the existing literature on QoL in early stage lung cancer patients who underwent surgical treatment.

      Methods:
      PubMed and PsycINFO were searched for articles published between 1995 (year of the last published meta-analysis) and March 21, 2016. All English articles reported on quality of life for Stage I NSCLC were included. Data extraction was performed by two independent reviewers using pre-specified criteria.

      Results:
      Ten articles from nine studies were identified. Of the nine studies, four reported on the SF-36, one on the SF-12, one on the EORTC QLQ-C30, one on POMS-TMD, one on EQ-5D, and one on SGRQ. One study reported only on pre-surgical QoL, six only on post-surgical QoL and two studies reported on both pre- and post- surgical QoL. Timing for the administration of post-surgical QoL survey varied, from time at discharge to up to six years post-surgery. Two studies included only NSCLC patients with COPD. Due to the heterogeneity of these studies, comparison between studies and traditional meta-analysis were not possible.

      Conclusion:
      The literature on QoL in Stage I NSCLC patients is very sparse. As CT screening for lung cancer becomes more widespread with a consequent shift from late to early stage NSCLC, additional research is needed to explore the impact of different NSCLC surgical approaches on QoL.

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      P1.05-073 - Evaluation of Stage 1 Sub-Solid Lung Nodules Using PET Imaging (ID 4287)

      14:30 - 15:45  |  Author(s): C.I. Henschke

      • Abstract

      Background:
      Positron emission tomography (PET) scans are valuable in the evaluation of lung nodules. Subsolid (SS:<80% solid) lung nodules, however, often have low levels of metabolic activity and rare metastases. The purpose is to assess PET in the evaluation of SS nodules.

      Methods:
      Between 2009-2015, 892 patients had a chest computed tomography (CT) with a SS finding and PET within 6 months, with pathology specimen, at our institution. 50 patients had clinical stage IA/B lung cancer and were retrospectively analyzed. CT analysis further classified these subsolid lesions as nonsolid(NS) and part-solid(PS).

      Results:
      26 patients had NS nodules and 24 PS. Mean maximal tumor dimension was not statistically significantly different between the groups (mean±SD; NS- 16.8±6.9; PS- 16.9±6.2). PET positive nodules (SUV>2.5) were larger in maximal tumor dimension than PET negative on CT though the difference was not statistically significant (mean±SD; PET Neg, n=42- 16.1±5.7; PET-pos, n=8- 20.9±8.8). Among the 39 patients in which lymph node pathology was obtained, sensitivity and specificity of PET in identifying N1 disease was 0% and 92.9%; and 0% and 100% for N2 disease. Recurrence and overall survival were 0% and 100%, with median follow-up of 34 months. Figure 1



      Conclusion:
      The use of PET for the evaluation of SS nodules in stage I lung cancer may have limited value in detecting metastases and affecting current clinical decision making for these patients.

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    P2.06 - Poster Session with Presenters Present (ID 467)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Scientific Co-Operation/Research Groups (Clinical Trials in Progress should be submitted in this category)
    • Presentations: 1
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      P2.06-045 - Initiative for Early Lung Cancer Research on Treatment (IELCART) (ID 4620)

      14:30 - 15:45  |  Author(s): C.I. Henschke

      • Abstract

      Background:
      Randomized controlled trial evidence to guide treatment of early stage lung cancer has been challenging for a variety of reasons. There is now increasing recognition of the power of large databases collected in the context of clinical care to provide important information and there are new statistical techniques for analysis to address unrecognized confounders. We have initiated a new multi-center, international collaborative network for this purpose.

      Methods:
      Based on an extensive literature review, scientific articles, and a series of focus sessions with a panel of expert surgeons, as well a panel of former patients, a series of critical questions regarding treatment of early lung cancer has been developed. Data forms of relevant data from both physicians and patients pre- and post-surgery to account for potential confounders have been developed, tested, and are being entered into a web-based data collection system that also includes relevant imaging data. Sites are being registered into this new network

      Results:
      The four primary questions we found needing additional evidence that would be of most concern in regard to treatment of early lung cancer were the following Under what circumstances should limited resection be performed? How large should resection margins be when performing limited resection? When should a watchful waiting approach be considered? When should radiotherapy be considered an option for primary treatment The entire Mount Sinai Health System network which includes 5 hospitals has started enrollment. Treatment is according to usual care but documented in the IELCART registry. Four additional health systems are in the process of joining which requires completing the enrollment application and obtaining IRB approval to submit data to the IELCART registry. Since starting in March 2015, we have enrolled over 30 participants. Actual time required by the surgeon to complete the surgical data prior to surgery is a few minutes. Time to the patient and coordinator to complete the data forms prior to surgery requires between 30 and 60 minutes.

      Conclusion:
      We anticipate that approximately 10 health care systems will ultimately enroll in the IELCART. Within 2 years, we anticipate starting to have statistically meaningful results in answering the relevant questions. Beyond these, the IELCART registry by continuing to collect data as part of routine clinical practice will provide an important resource to answer future questions in a timely manner as they arise, including performing studies in the neo-adjuvant setting and companion diagnostics.