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E. Koh
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OA 04 - Surgery from Minimal to Radical (ID 661)
- Event: WCLC 2017
- Type: Oral
- Track: Surgery
- Presentations: 1
- Moderators:J. Lee, A. Chang
- Coordinates: 10/16/2017, 15:45 - 17:30, Room 311 + 312
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OA 04.05 - Intermediate Results of ICG Anatomical Segmentectomy Based on the Virtual Segmentectomy Simulation (ID 8050)
15:45 - 17:30 | Author(s): E. Koh
- Abstract
- Presentation
Background:
The confirmation of an appropriate resection margin from the tumor is crucial for reducing the risk of local recurrence after lung segmentectomy for pulmonary malignancies. And the precise anatomical segmentectomy is also important for preserving pulmonary function. We evaluated intermediate results of tumor recurrence after anatomical ICG segmentectomy based on the virtual segmentectomy simulation.
Method:
From August 2014 to May 2017, forty-five patients underwent pulmonary segmentectomy under the guidance of ICG fluorescence. Before operation, several types of virtual segmentectomy were created by using Volume Analyzer Synapse VINCENT (Fujifilm co., Tokyo, Japan). We measured the shortest distance from the tumor to the resection margin in each simulated segmentectomy and selected the most appropriate area of sublobar resection based on the adequate resection margin of approximately 2 cm from the tumor. After this virtual segmentectomy, we performed segmentectomy by using an infrared thoracoscopy with transbronchial ICG instillation. Before operation, 10ml of 10-fold diluted ICG with autologous blood and 400ml of air were instilled into each associated subsegmental bronchus. Segmentectomy was performed under ICG visualization. We evaluated tumor recurrence and survival after the operation.
Result:
Thirty-seven patients were primary lung cancer and eight patients were metastatic lung tumor. Active limited resection was done in 28 patients, passive limited resection was in nine and metastatic lung tumor resection was in eight. Subsegmental resection was done in five, segmental resection in 22 and extended segmentectomy, which indicates resection of several segments with adjacent subsegment(s), was 18. The average shortest distance from the tumor to the resection margin in simulation and resected specimen were 22.5+/-11.7 mm and 24.1+/-7.3 mm, respectively (p=0.405). Postoperative complications were prolonged air leak longer than seven days in two cases and atrial fibrillation in one. In terms of the recurrence and survival after ICG segmentectomy, although the mean duration of follow-up was still short (530+/-349 days), no cancer recurrence in the ipsilateral lung was identified in lung cancer patients. In particular, no recurrence was found in the lung as well as lymph node in active segmentectomy patients.
Conclusion:
The combination of lung volume analyzer and ICG segmentectomy was an excellent tool for precise anatomical segmentectomy with an appropriate resection margin and excellent control of tumor recurrence.
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P2.09 - Mesothelioma (ID 710)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Mesothelioma
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.09-006 - FISH Analysis of p16 and BAP1 Immunohistochemistry for the Diagnosis of Mesothelioma (ID 9144)
09:30 - 16:00 | Author(s): E. Koh
- Abstract
Background:
Distinction between mesothelioma and reactive mesothelial proliferation is difficult because of cytological and morphological overlap between these conditions. It is also difficult to differentiate sarcomatoid mesothelioma from fibrous pleuritis on biopsy. However, separation of reactive mesothelial proliferation from epithelioid mesothelioma and that of fibrous pleuritis from sarcomatoid mesothelioma is important because of therapeutic option and prognosis of the patients. There are some reports claiming that ancillary techniques such as fluorescence in situ hybridization (FISH) analysis of p16 and immunohistochemistry of BAP1 improve the diagnostic accuracy of mesothelioma. However, reported sensitivity of p16 FISH and BAP1 loss is different depending on the subtype of mesothelioma and on studies from various authors. The aim of this study was to elucidate the frequency of p16 deletion and BAP1 loss in mesotheliomas by multiple institutions in Japan.
Method:
We collected 262 malignant pleural mesotheliomas, 29 malignant peritoneal mesotheliomas, 23 cases with reactive mesothelial proliferation, and 37 cases with fibrous pleuritis from Tokyo Women’s Medical University, Chiba Rosai Hospital, Fukuoka University, Hyogo Medical University, Kagawa University, and Kanagawa Cancer Center. FISH analysis was performed with p16 probe. Immunostaining was performed with anti-BAP1 antibody.
Result:
We analyzed 262 pleural mesotheliomas (170 epithelioid, 38 biphasic, and 54 sarcomatoid) with p16 FISH, and 92 pleural mesotheliomas (58 epithelioid, 20 biphasic and 14 sarcomatoid) with BAP1 immunohistochemistry. Homozygous deletion (HD) of p16 was observed in 74% of epithelioid, 92% of biphasic, and 100% of sarcomatoid mesotheliomas. BAP1 loss was observed in 64% of epithelioid mesotheliomas and 55% of biphasic mesotheliomas, but not in sarcomatoid mesotheliomas. Concordance of HD of p16 and BAP1 loss between epithelioid and sarcomatoid components of 19 biphasic mesotheliomas was 100%. We analyzed 29 peritoneal mesotheliomas (25 epithelioid, 2 biphasic, and 2 sarcomatoid) with p16 FISH and 9 peritoneal epithelioid mesotheliomas with BAP1 loss. HD of p16 was observed in 52% of epithelioid mesotheliomas, 50% of biphasic mesotheliomas, and 50% of sarcomatoid mesotheliomas. BAP1 loss was observed in 56% of epithelioid mesotheliomas. No case with reactive mesothelial proliferation or fibrous pleuritis harbored HD of p16 and showed BAP1 loss.
Conclusion:
Separation of epithelioid or biphasic mesothelioma from reactive mesothelial proliferation may be possible with p16 FISH and/or BAP1 immunohistochemistry. Because all of the pleural sarcomatoid mesotheliomas but no cases with fibrous pleuritis harbor HD of p16, p16 FISH helps the separation of sarcomatoid mesothelioma from fibrous pleuritis, but BAP1 does not.
