Virtual Library

Start Your Search

Kyle Grant



Author of

  • +

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

    • Event: WCLC 2018
    • Type: Mini Oral Abstract Session
    • Track: Screening and Early Detection
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 10:30 - 12:00, Room 206 AC
    • +

      MA03.02 - Prospective Evaluation of the Clinical Utility of the International Lung Screen Trial Lung Nodule Management Protocol (ID 14043)

      10:35 - 10:40  |  Author(s): Kyle Grant

      • 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).

      a9ded1e5ce5d75814730bb4caaf49419 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).

      4c3880bb027f159e801041b1021e88e8 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.

      8eea62084ca7e541d918e823422bd82e 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

      6f8b794f3246b0c1e1780bb4d4d5dc53

      Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.

  • +

    OA09 - Prevention and Cessation (ID 909)

    • Event: WCLC 2018
    • Type: Oral Abstract Session
    • Track: Prevention and Tobacco Control
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 15:15 - 16:45, Room 205 BD
    • +

      OA09.07 - Association Between Outdoor Air Pollution And Lung Cancer in Female Never Smokers (ID 14485)

      16:20 - 16:30  |  Author(s): Kyle Grant

      • Abstract
      • Presentation

      Background

      Long term exposure to ambient particulate matter (PM2.5) has been associated with an increased risk of developing lung cancer, and is estimated to be responsible for ~23% of global lung cancer deaths. No current lung cancer screening risk prediction model uses air pollution as an individual risk factor in its risk calculation. As smoking rates decrease globally, and air pollution increases, it is important to assess the effect of long term outdoor air pollution exposure on lung cancer risk especially in never smokers.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We enrolled 421 patients with newly diagnosed lung cancer presenting to BC Cancer and conducted a detailed residential history from birth to estimate their air pollution exposure since 1996 when accurate high-resolution concentration estimates of PM2.5 particulate matter derived from satellite observations and ground measurements became available. The average PM2.5 exposure was quantified by combining residential histories with exposure data.

      4c3880bb027f159e801041b1021e88e8 Result

      The demographics of the 262(62%) ever smokers, and 159(38%) never smokers with lung cancer are shown in Table 1. Median exposure of all cancer patients was 7.1 PM2.5 ug/m3 (IQR 6.8-7.3; Range 4.3-65.8). Of the ever smokers, 6.1% had a PM2.5 >10 ug/m3 whereas 15.1% of the never smokers had a PM2.5 >10 ug/m3. Among never smokers with lung cancer with high PM2.5 exposure >10 ug/m3, 74% were female and 83% were of Asian descent. Using a logistic regression model, we demonstrated a significant association between air pollution exposure and never smokers compared to ever smokers in women: Odds Ratioper_1_LN-transformed unit = 12.05 (p<0.001). This association was absent in males (interaction p=0.006).

      8eea62084ca7e541d918e823422bd82e Conclusion

      table1.jpgIn women with lung cancer, outdoor air pollution exposure was significantly higher in never smokers than in ever smokers. This association was not observed in men with lung cancer.

      6f8b794f3246b0c1e1780bb4d4d5dc53

      Information from this presentation has been removed upon request of the author.

      Information from this presentation has been removed upon request of the author.

  • +

    P1.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 948)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
    • +

      P1.16-34 - The Impact of Pathology, Staging and Operative Resection on Survival and CT Evidence of Recurrence of Early NSCLC (ID 12616)

      16:45 - 18:00  |  Author(s): Kyle Grant

      • Abstract

      Background

      The purpose of this study is to determine the impact of histopathology, staging and extent of operative resection on survival and CT evidence of recurrence of early NSCLC excised with VATS wedge resection guided by preoperative CT-guided microcoil localization (CTML) and intra-operative fluoroscopic guidance.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Between April 2003, to June 2012, 106 of 154 patients who underwent CTML and VATS resection of suspicious pulmonary nodules were found to have NSCLC. Serial chest CTs of the 106 patients with confirmed NSCLC were reviewed by 2 chest radiologists for development of recurrence of the original cancer at the resection margin, lung or mediastinum and the development of new primary lung cancer. 53 patients underwent CTML and VATS resection alone and 53 had CTML, VATS diagnostic resection followed by VATS therapeutic lobectomy. An experienced chest pathologist determined pathologic resection margins, histological subtype and staging.

      4c3880bb027f159e801041b1021e88e8 Result

      The male/female ratio was 47/59. Median age was 63 (34-81) years. Smoking history obtained in 91/106. Median follow-up was 82 (32-136) months. Histology consisted of 99 adenocarcinomas and 7 squamous carcinomas. Staging (AJCC 8th edition) was Stage 0 (11), IA1 (77), IA2 (2), IA3 (3) IB (8), IIB (4) & IV (1). Both surgical groups were similar for demographics, tumor characteristics, histopathology and stage at surgery; there was no 90-day mortality. Multivariate analysis showed adverse effects on: 1) Local recurrence of cancer (n=3) by positive resection margin (n=2) ***. 2) Any recurrence of original cancer (n=10) by lymph node stage ***, positive resection margin ***, visceral pleural invasion (VPI) *** but not age, gender, smoking history, nodule shape on CT, histopathology, tumor invasive size, STAS, lymphovascular invasion or extent of resection. 3) Development of a new primary NSCLC (n=19) by wedge resection alone* (12/19). The new primary was resected in 13/19 patients. 4) Disease free survival at 3 (89%), 5 (74%) & 9 years (61%) by a positive resection margin ***, VPI **, lymph node stage*, or wedge resection alone *. Overall 5-year survival was 85%. (p<.05 *,p<.01 **, p<.001***)

      8eea62084ca7e541d918e823422bd82e Conclusion

      In patients with early NSCLC, CTML accurately identifies the cancer margins resulting in a low radiologic local recurrence rate of 3%. Ten patients had recurrence of their original cancer associated with lymph node involvement, positive resection margin, and VPI. Second primary lung cancers are prevalent in long-term survivors, particularly if treated with wedge resection. Completion therapeutic lobectomy following diagnostic wedge resection of NSLC improves disease-free survival.

      6f8b794f3246b0c1e1780bb4d4d5dc53