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R. Miyazaki



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    P1.02 - Biology/Pathology (ID 614)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Biology/Pathology
    • Presentations: 1
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      P1.02-034 - Non-Invasive Qualitative Diagnosis of Lung Cancer Enabled by Spectrum Analysis of Ultrasound (ID 9376)

      09:30 - 16:00  |  Author(s): R. Miyazaki

      • Abstract

      Background:
      Ultrasound has been widely utilized in clinical to visualize the internal structure of the objective non-invasively. However ultrasound image can’t distinguish malignant lesion from the normal tissue. Spectrum analysis of ultrasound is a newly developed technology which may reflect on the histological feature. We examine if the spectrum analysis is able to distinguish malignant tissue from normal tissue.

      Method:
      Spectrum was measured using a prototype ultrasound processor EUME5 given by Olympus Japan. three parameters of spectrum such as Midband-fit(M), Intercept(I), and Slope(S) were measured for the objective tissue. In animal study, human lung cancer Xenograft were created in nude mice for each lung cancer cell line (A549, H460, HCC827, and H3122). In clinical setting, surgically excised lungs including lung cancers were examined spectrum analysis for both lung cancers (n=19, 106 slices) and normal lungs (n=17, 65 slices).

      Result:
      Four different Xenografts exhibited significant differences of spectrum data. In the clinical study, the mean value of M, I and S of both lung cancers and normal lungs were M: -43.22 ±4.09 vs -39.31±3.87(p<0.01,) I: -55.28±3.19 vs -54.13±2.4 (N.S), S: -1.43±0.35 vs -1.73±0.30 (p<0.01)

      Conclusion:
      Each lung cancer Xenograft of different histology showed different spectrum value. Spectrum analysis is likely to reflect the histological feature. In clinical, M and S showed statistically different values between lung cancer and normal lung. Based on spectrum value, a malignant tumor can be distinguished from the normal lung in the ultrasound image.

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    P1.05 - Early Stage NSCLC (ID 691)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Early Stage NSCLC
    • Presentations: 1
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      P1.05-003 - Impact of Coexisting Pulmonary Diseases on Oncological Outcomes of Patients with pStage I Non-Small Cell Lung Cancer (ID 7923)

      09:30 - 16:00  |  Author(s): R. Miyazaki

      • Abstract
      • Slides

      Background:
      Cigarette smoking is a well-known cause of interstitial lung diseases (ILDs), pulmonary emphysema, and lung cancer. Coexisting pulmonary diseases can affect outcomes of patients with early-stage lung cancer. The aim of this study was to analyze the influence of pulmonary diseases upon oncological outcomes of patients with smoking history who underwent surgery for pStage I non-small cell lung cancer (NSCLC).

      Method:
      Medical records of a total of 227 patients with smoking history (current/former) who underwent anatomical lung resections (200 lobectomies and 27 segmentectomies) for pStage I NSCLC between June 2009 and December 2014 were reviewed. Coexisting ILDs were evaluated on high-resolution computed-tomography (HRCT). The degree of pulmonary emphysema was determined using image analysis software, applying Goddard classification. The impact of clinicopathologic factors including pulmonary diseases on oncological outcome was evaluated.

      Result:
      Among the 227 patients, ILDs on HRCT were detected in 47 (20.7%) patients; of those, UIP pattern and non-UIP pattern were seen in 19 (8.4%) and 28 (12.3%) patients, respectively. The degree of pulmonary emphysema was classified into normal, mild and moderate, including 44 (19.4%), 146 (64.3%) and 37 (16.3%) patients, respectively. Pathological stages were IA in 131 patients and IB in 96. The 5-year overall survival (OS) and cancer-specific survival (CSS) were 81.2% and 88.2%, respectively. Univariate analysis showed that UIP-pattern on HRCT, moderate pulmonary emphysema, vascular invasion, visceral pleural invasion (VPI), and pStage IB were correlated with poor CSS. Cox proportional hazards models revealed that the presence of UIP-pattern and VPI were independent risk factors for poor CSS. During a median follow-up period of 42.7 months, recurrent diseases were seen in 41 (18.1%) patients. Multiple logistic regression analysis showed that the presence of UIP-pattern and VPI were significantly related with tumor recurrence.

      Conclusion:
      The coexistence of UIP-pattern ILD on HRCT was shown to negatively affect the oncological outcome of patients with smoking history who underwent surgery for pStage I NSCLC.

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    P1.16 - Surgery (ID 702)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Surgery
    • Presentations: 1
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      P1.16-026 - Multimodal Image-Guided VATS Resection of Sub-Centimeter Pulmonary Nodules by Cone Beam CT and Bronchoscopic NIR Fluorescence Marking (ID 9222)

      09:30 - 16:00  |  Author(s): R. Miyazaki

      • Abstract

      Background:
      Small-sized pulmonary nodules such as ground grass nodule and metastatic nodules are difficult to identify the localization during video-assisted thoracic surgery (VATS). The authors have developed the bronchoscopic indocyanine green fluorescence (ICG-FL) marking of small-sized pulmonary nodules to localize them durging VATS. The ICG-FL marking have some advantages. Near infra-red (NIR) light has excellent tissue penetrating property so that the ICG-FL marked in the lung parenchyma can be detected from the surface of lung with ICG-FL detecting thoracoscope. Also, NIR fluorescence spectrum can be isolated from the visible color spectrum so that ICG-FL can be detected with high sensitivity regardless of the color tone of the background lung. In the current study, taking advantage of the hybrid operating room (Hybrid OR), all procedures such as navigation bronchoscopic injection of ICG, real-time image-guidance by cone beam CT, intraoperative detection of ICG-FL and VATS wedge resection were performed all at one time under general anesthesia. The purpose of the current study was the validation of the presenting procedure in terms of the accuracy of localization, the surgical invasiveness, and operation time.

      Method:
      The patients with sub-centimeter pulmonary nodules which were diagnosed as the indication of video-assisted wedge pulmonary resection were enrolled in the study (n=5). At Hybrid OR under general anesthesia, thin bronchoscope was inserted into the peripheral bronchus which lead to the pulmonary nodule. Virtual bronchoscopy navigation was utilized to increase the accuracy of bronchoscopy. Transbronchial aspiration cytology (TBAC) needle was inserted to peripheral bronchus adjucent to the pulmonary nodule. After confirming the location of TBAC needle by Cone beam CT, the 0.05mL of 0.025mg/mL of ICG mixed with iopamidol was injected into lung parenchyma. During VATS resection, the infra-red fluorescence spot of ICG adjucent to the pulmonary nodules were visualized by ICG-FL thoracoscopy (Pin-point, Novadaq. Canada). The successful pulmonary resection was confirmed with macro- and microscopic examination during surgery.

      Result:
      ICG-FL marking was successful in all 5 cases 8 lesions without any complication. All tumors were successfully excised with the sufficient surgical safety margin. No adverse events were experienced throughout the entire study.

      Conclusion:
      Cone-beam CT in Hybrid OR can increase the accuracy of bronchoscopic ICG-FL marking. Multimodal cone-beam CT-guided bronchoscopic ICG-FL marking is a precise method to excise the multiple, small-sized pulmonary noddules by minimally invasive thoracic surgery.

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    P3.09 - Mesothelioma (ID 725)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Mesothelioma
    • Presentations: 1
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      P3.09-005 - The Results of Trimodality Treatment Strategy for Malignant Pleural Mesothelioma (ID 8725)

      09:30 - 16:00  |  Author(s): R. Miyazaki

      • Abstract
      • Slides

      Background:
      Our standard treatment strategy for operable malignant pleural mesothelioma (MPM) is trimodality therapy with extrapleural pneumonectomy (EPP) followed by radiation and chemotherapy. Our experience to treat MPM is reported.

      Method:
      45 consecutive EPP for MPM which were performed from June 2006 to February 2017 in our hospital were reviewed. We have instituted a trimodality therapy protocol consisting of EPP, adjuvant 45-50.4 Gy hemithoracic radiation, and adjuvant CDDP plus PEM chemotherapy. 36 patients have been treated with this protocol. However, 9 patients were given induction chemotherapy, and referred to us. They were scheduled to undergo EPP and adjuvant radiation. Overall survival was calculated using Kaplan-Meier method.

      Result:
      Median age at EPP was 61 years old (44-74). Female was 11, and male was 34. Right side was 25, and left side was 20. Epithelioid was 30, biphasic was 10, sarcomatoid was 2, and special variants was 3. Median EPP time was 7 hours 30 minutes (5 h 52 m-12 h 2 m). No blood transfusion during EPP was 17 cases (38%). Mortality was one patient (2.2%) who died due to acute aggravation of interstitial pneumonia. Atrial fibrillation was the most common morbidity, and developed in 16 patients (36%). IMIG pathological stage was stage IV in 3, stage III in 26, stage II in 8, and stage Ib in 8. Adjuvant 45-50.4 Gy radiation was completed for 38 patients (83%). 10 patients (22%) could not undergo chemotherapy. 31 patients (69%) underwent trimodality therapy. Postoperative median follow-up period was 5 years and 10 months. Five year survival, two year survival, and median survival of all 45 patients (graph) were 32%, 44%, and 17.4 months, and those of 30 epithelioid patients were 41%, 54%, and 30.4 months.Figure 1



      Conclusion:
      This trimodality treatment strategy with EPP, radiation, and chemotherapy for MPM is feasible, and the prognosis has been greatly improved.

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