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C.A.M. Sousa

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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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      P1.02-036 - Fine Needle Aspiration as a Diagnostic Tool in Lung Cancer: Worth Pursuing? (ID 9581)

      09:30 - 16:00  |  Author(s): C.A.M. Sousa

      • Abstract
      • Slides

      The diagnosis of lung cancer can be challenging due to different forms of disease presentation, coupled with institutional familiarity with specific techniques. Transthoracic fine needle aspiration (FNA) is relatively simple and inexpensive, yielding diagnostic material in 70-95% of cases. In the era of personalized oncology where immunohistochemical and molecular assays may be required, the role of FNA to provide enough material should be reassessed.

      This is a prospective study designed to evaluate the feasibility and safety of FNA as a primary technique in the diagnosis of lung tumors. Patients were randomized in a 1:1 ratio into two arms, one using conventional FNA needle (control arm) and another using coaxial needle (experimental arm). Eligible patients were at least 18 years old and had a lung mass suspicious of lung cancer. The procedure was performed in an outpatient clinic, under local anesthesia, by an experienced thoracic surgeon in the presence of a pathologist. The primary endpoint was a positive cell block containing at least 40% of neoplastic cells, a surrogate for successful additional assays. We present the first interim analysis. This study was approved by the Ethics Committee.

      Between January 2013 and May 2015, 34 patients were enrolled, 17 in each arm. The cohort was mostly comprised of males (62%) and smokers (91%), with a median age of 66 years (range 51-85). Most cases were assessed with a computed tomography (94%), with target tumor measuring a median of 8.2 cm (range 1-13 cm). Baseline characteristics were well balanced between the 2 arms, except for gender (82% males in the experimental arm, 41% in the control arm). A positive cell block was acquired in 9 (53%) and 7 (41%) cases in the experimental and control arms, respectively. Altogether, a positive cell block was acquired in 16 cases (47%). A diagnosis was obtained in 82% of cases, but histological subtyping was only possible in 73%. The cell block positivity rate was significantly associated with histological subtyping (p<0.001). Local pain was the only adverse event, reported in 2 cases in each arm.

      FNA was a safe procedure in both arms, but yielded enough tumor material in less than half patients and was less than optimal to determine histological subtyping. No relevant difference was observed between conventional and coaxial needle, neither for safety nor for efficacy. FNA alone should not be considered a standard procedure in most cases suspicious for lung cancer.

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