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L. Irving
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MA05 - Innovative Techniques in Pulmonology and the Impact on Lung Cancer (ID 378)
- Event: WCLC 2016
- Type: Mini Oral Session
- Track: Pulmonology
- Presentations: 1
- Moderators:J. Eckmayr, P.R. Mohapatra
- Coordinates: 12/05/2016, 16:00 - 17:30, Strauss 1
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MA05.03 - A Single EBUS-TBNA Pass Yields Sufficient DNA for Targeted Molecular Testing in Lung Cancer (ID 4682)
16:00 - 17:30 | Author(s): L. Irving
- Abstract
- Presentation
Background:
Development of drugs that target molecular pathways in lung cancer has made it increasingly important for diagnostic sampling to yield sufficient material for genotyping. At the same time, minimally invasive sampling techniques such as endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) result in smaller volume cytological specimens. It has been shown that at least 3 EBUS-TBNA passes per lesion are sufficient for cytological subtyping. However, the number of passes needed for mutational subtyping is unclear. We sought to determine the adequacy of a single EBUS-TBNA for genotyping clinically actionable mutations.
Methods:
Patients undergoing EBUS-TBNA for diagnosis of lung cancer were prospectively recruited. Paired samples from the same target lesion were obtained. The “reference” sample was the routine diagnostic specimen consisting of ≥3 passes, whereas the “study” sample comprised a single pass. DNA was extracted from both samples and subjected to quantitative and qualitative assessment. Sequencing for EGFR, KRAS, BRAF mutations was performed in adenocarcinoma/non-small cell lung cancer not otherwise specified (NSCLC-NOS) cases.
Results:
Samples were obtain in 41 patients. Cytological diagnosis was adenocarcinoma/NSCLC-NOS in 25 (61.0%), squamous cell carcinoma in 10 (24.4%), small cell lung cancer in 5 (12.2%), and carcinoid in 1 (2.4%) case. DNA extraction yielded a mean of 4.03μg, well above the minimum required quantity for targeted sequencing of 10ng (Table 1). DNA quality measured by DNA Integrity Number could be calculated in 35 (85%) cases with a mean of 8.9, where >7 is acceptable for sequencing (Table 1). Sequencing results of adenocarcinoma/NSCLC-NOS cases show mutations in EGFR in 6, KRAS in 8, BRAF in 1 case. Wild type was demonstrated in 6 cases. Molecular analysis of the corresponding study samples is proceeding.Table 1. DNA quantity and quality
Histological subtype Cases, n (%) Mean DNA quantity (μg) Mean DNA Integrity Number (DIN) Adenocarcinoma/NSCLC-NOS 25 (61.0) 3.83 8.8 Squamous cell carcinoma 10 (24.4) 2.65 9.0 Small cell lung carcinoma 5 (12.2) 5.28 9.0 Carcinoid 1 (2.4) 16.24 9.1 Overall 41 4.03 8.9
Conclusion:
A single EBUS-TBNA yields DNA of quantity and quality sufficient for molecular analysis, and is expected to be adequate for lung cancer genotyping.
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P2.07 - Poster Session with Presenters Present (ID 468)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Nurses
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.07-008 - Victorian Comprehensive Cancer Centre Lung Cancer Clinical Audit: Collecting the UK National Lung Cancer Audit data from Hospitals in Australia (ID 4784)
14:30 - 15:45 | Author(s): L. Irving
- Abstract
Background:
Clinical audit may improve best practice within health. The UK National Lung Cancer Audit (NLCA) collects data from UK hospitals about care of patients with thoracic cancers. We aimed to replicate collection of the NLCA data elements from hospitals caring for patients with thoracic cancers within the Victorian Comprehensive Cancer Centre (VCCC) and associated Western and Central Melbourne Integrated Cancer Service (WCMICS).
Methods:
Retrospective audit of patients newly-diagnosed with lung cancer or mesothelioma in 2013 at 6 major VCCC or WCMICS hospitals. The objectives were: to adopt/adapt the NLCA dataset for use in the Australian context; and analyze the findings using descriptive statistics to identify variations in care. Individual data items from the NLCA were tailored to the Australian context in consultation with an expert steering committee. Data was collected from existing datasets including the Victorian Cancer Registry, Victorian Admitted Episodes Dataset and individual hospital databases. Individual medical records were audited to collect missing data.
Results:
845 patients were diagnosed during 2013. Most were aged 65-80 (55%) and 62% were male. Most had non-small cell lung cancer (81%) with 9% small cell and 2% mesothelioma. Data completeness varied greatly between fields. Headline indicators of clinical care in the table below are compared to NLCA data. A significant area of concern identified was lack of access of many patients to a specialist lung cancer nurse.
Conclusion:
Lung cancer care at participating hospitals appeared to be comparable or better to many of the headline indicators of the NLCA. However, performing the audit retrospectively resulted in significant amounts of missing data for some fields. For future audits, prospective data collection should be harmonized across sites and correlated with survival outcomes. Initiatives to improve access to specialist lung cancer nurses are urgently needed.Benchmark VCCC/WCMICS (%) NLCA-2013 (%) Patients with histological diagnosis 810/845 (96%) (75%) Patients with CT before bronchoscopy 384/492 (78%) (91%) NSCLC patients receiving PET scan 544/748 (73%) (35%) Patients with stage documented 518/845 (61%) (93%) Patients discussed at multi-disciplinary meeting 585/845 (69%) (96%) Patients seen by lung cancer nurse specialist 110/845 (13%) (84%) Lung cancer nurse specialist present at diagnosis 0/845 (0%) (65%) Patients receiving active treatment 643/845 (76%) (60%) Patients treated with surgery 242/845 (29%) (15%) Patients treated with radiotherapy 370/669 (55%) (29%) Patients treated with chemotherapy 327/638 (51%) (70%) Patients seen by specialist palliative care 179/845 (21%) (30%)
