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Kwun M Fong



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    MA03 - Lung Cancer Screening - Next Step (ID 896)

    • Event: WCLC 2018
    • Type: Mini Oral Abstract Session
    • Track: Screening and Early Detection
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/24/2018, 10:30 - 12:00, Room 206 AC
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      MA03.02 - Prospective Evaluation of the Clinical Utility of the International Lung Screen Trial Lung Nodule Management Protocol (Now Available) (ID 14043)

      10:35 - 10:40  |  Author(s): Kwun M Fong

      • Abstract
      • Presentation
      • Slides

      Background

      Several protocols are available to guide management of lung nodules identified by low-dose screening CT. It is important to objectively assess their clinical utility in order to weigh the potential harm versus potential beneficial impacts of the following: early recall imaging studies/biopsy and health care resource utilization. We aimed to prospectively evaluate clinical utility of the PanCan lung nodule management protocol in the International Lung Screen Trial (ILST).

      Method

      Ever smokers age 55 to 80 years were enrolled into ILST if they has a ≥30 pack-years smoking history and smoked within 15 years or if their PLCO m2012 6 year lung cancer risk was ≥1.51%. Figure 1 shows the ILST lung nodule management protocol based on the PanCan nodule malignancy risk calculator (NEJM 2013;369:908 & BMJ 2014;348:g2253).

      Result

      Since July 2016, 757 ever smokers (mean age 65 years, 44% female, 15% non-Caucasian) had been enrolled. The distribution of malignancy risk categories (CAT) were: CAT1 70%, CAT2 15%, CAT3 11%, CAT4 3.5%, CAT5 0.4%. CT biopsy or bronchoscopic biopsy for diagnosis/staging was done in 16/26 CAT 4 (62%) and 7/84 CAT 3 (8%) participants. Lung cancer was confirmed in 15/757 (2%). Thus far, surgery was performed in 9 CAT 4 and 2 CAT 3 participants, with one benign resection (9%) for a growing FDG avid nodule. Of the 3 CAT5 participants, one was found to have granulomatous changes in an enlarged paratracheal lymph node and two had segmental atelectasis due to mucoid impaction.

      Conclusion

      The ILST protocol triaged 70% of the screening cohort with low malignancy risk to biennial screening instead of annual repeat screening. Participants with high malignancy risk (CAT 4+5) were triaged to a diagnostic pathway (4%). Our preliminary results suggest the ILST protocol may decrease resource utilization and potentially minimize risk of screening for participants.

      figure1 ilst lung nodule management protocol.jpg

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    MA20 - Implementation of Lung Cancer Screening (ID 923)

    • Event: WCLC 2018
    • Type: Mini Oral Abstract Session
    • Track: Screening and Early Detection
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/25/2018, 15:15 - 16:45, Room 206 F
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      MA20.01 - Lung Cancer Screenee Selection by USPSTF versus PLCOm2012 Criteria – Preliminary ILST Findings (Now Available) (ID 14331)

      15:15 - 15:20  |  Author(s): Kwun M Fong

      • Abstract
      • Presentation
      • Slides

      Background

      Background

      The National Lung Screening Trial showed that lung cancer screening of high-risk individuals with low dose computed tomography can reduce lung cancer mortality by 20%. Critically important is enrolling high-risk individuals. Most current guidelines including the United States Preventive Services Task Force (USPSTF) and Center for Medicare and Medicaid Services (CMS) recommend screening using variants of the NLST eligibility criteria: smoking ≥30 pack-years, smoking within 15 years, and age 55-80 and 55-77 years. Many studies indicate that using accurate risk prediction models is superior for selecting individuals for screening, but these findings are based on retrospective analyses. The International Lung Screen Trial(ILST) was implemented to prospectively identify which approach is superior.

      Method

      Methods

      ILST is a multi-centred trial enrolling 4000 participants. Individuals will be offered screening if they are USPSTF criteria positive or have PLCOm2012 model 6-year risk ≥1.5%. Participants will receive two annual screens and will be followed for six years for lung cancer outcomes. Individuals not qualifying by either criteria will not be offered screening, but samples of them will be followed for lung cancer outcomes. Outcomes in discordant groups, USPSTF+ve/PLCOm2012-ve and USPSTF-ve/PLCOm2012+ve, are informative. Numbers of lung cancers, abnormal suspicious for lung cancer scans (a marker of future lung cancers) and individuals enrolled, and sensitivity and specificity and positive predictive values of the two criteria will be compared.

      Result

      Results

      As of March 2018, ILST centers in Canada (British Columbia and Alberta), Australia, and the United Kingdom had enrolled and scanned 1938 individuals. Study results are summarized in Figure 1.

      fig1.jpg

      Conclusion

      Conclusion

      Interim analysis of ILST data, suggests that classification accuracy of lung cancer screening outcomes support the PLCOm2012 criteria over the USPSTF criteria. Individuals who are USPSTF+ve and PLCOm2012-ve appear to be at such low baseline risk (0.46%) that they may be unlikely to benefit from screening.

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    MS06 - Practical Issues in the Management of Oligometastatic NSCLC (ID 785)

    • Event: WCLC 2018
    • Type: Mini Symposium
    • Track: Oligometastatic NSCLC
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/24/2018, 13:30 - 15:00, Room 206 BD
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      MS06.02 - The Role of Interventional Pulmonology and Radiology (Now Available) (ID 11424)

      13:45 - 14:00  |  Presenting Author(s): Kwun M Fong

      • Abstract
      • Presentation
      • Slides

      Abstract

      The Role of Pulmonology and Interventional Radiology in the Management of Oligometastatic NSCLC

      Oligometastatic disease is a difficult management issue when encountered in NSCLC. Often defined as low metastatic burden and limited organ involvement disease, with clinical impact perceived as between truly localised potentially curable disease and a extensive incurable metastatic tumour, therefore with major implication for the patient in terms of treatment, with the potential to pivot the decision making from palliative to curative intent.

      In addition the site(s) of oligometastatic disease is heterogenous with potential to affect any site in the body, both intra and extra- thoracic, thus requiring a truly multidisciplinary approach to its management.

      It is essential to make an accurate diagnosis, to consider synchronous cancers and to rule out more extensive metastatic disease given the differing management strategies required.

      For the Pulmonologist and Interventional Radiologist, for intrathoracic oligometastatic disease, the issues are the diagnostic challenges and potential therapeutics. The use of image guided trans thoracic needle biopsy has long been used effectively by Interventional Radiology for the pathological diagnosis of suspected lesions. With modern endobronchial ultrasound, Pulmonologists are able to contribute more by accessing central and peripheral lung lesions by navigation and guided bronchoscopy e.g. ultrasound guided, electromagnetic navigation and transparenchymal approaches. With the increasing use of molecular techniques to distinguish cancers even of the same morphological appearance, such diagnostic approaches are of increasing clinical utility.

      For intrathoracic therapeutics, local Interventional Radiology ablative techniques such as radiofrequency ablation has long been used, with microwave ablation increasingly popular. In parallel with diagnostics, emerging Pulmonology techniques are also researching the potential application of these techniques applied endobronchially in addition to new modalities such as steam ablation.

      Interventional Radiologists also have a useful role to play in the management of extra-thoracic oligometastatic disease, as techniques such as radiofrequency and microwave ablation can be used such as for liver lesions.

      This session will review the emerging data for the key role of Pulmonology and Interventional Radiology in the Management of Oligometastatic NSCLC.

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    S01 - IASLC CT Screening Symposium: Forefront Advances in Lung Cancer Screening (Ticketed Session) (ID 853)

    • Event: WCLC 2018
    • Type: Symposium
    • Track: Screening and Early Detection
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/23/2018, 07:00 - 12:00, Room 203 BD
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      S01.17 - Session V: Panel Discussion: Next Steps for Lung Screening? (Now Available) (ID 11898)

      10:30 - 11:30  |  Presenting Author(s): Kwun M Fong

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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