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John Mayo
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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
- 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 (ID 14043)
10:35 - 10:40 | Author(s): John Mayo
- Abstract
- Presentation
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.
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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
- 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 (ID 14331)
15:15 - 15:20 | Author(s): John Mayo
- Abstract
- Presentation
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.
a9ded1e5ce5d75814730bb4caaf49419 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.
4c3880bb027f159e801041b1021e88e8 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.
8eea62084ca7e541d918e823422bd82e 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.
6f8b794f3246b0c1e1780bb4d4d5dc53Only 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.
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P1.11 - Screening and Early Detection (Not CME Accredited Session) (ID 943)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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P1.11-10 - Optimizing Radiomics Features by Minimizing Boundary Effects and Normalizing with Opposite Lung Tissue Characteristics (ID 14062)
16:45 - 18:00 | Author(s): John Mayo
- Abstract
Background
For wide adoption of LDCT screening it is thought that CAD will likely by necessary. We hypothesize that CAD features that minimizes perimeter effects and normalizes nodule CT features using the lung parenchyma from the opposite lung will improve the ability to determine nodule malignancy.
a9ded1e5ce5d75814730bb4caaf49419 Method
We have developed a CAD system that includes lung tissue segmentation, nodule detection and feature extraction from the segmented nodule, the segmented nodule minus the perimeter transition pixels (Core), and the opposite lung parenchymal tissue. (See Figure 1).
We use the Mann-Whitney U test to compare teh discriminating ability of individual features and combinations of features) extracted from the nodule, nodule core and nodule normalized by mirror region features.
4c3880bb027f159e801041b1021e88e8 Result
In total, 34 early small suspect baseline nodules detected as part of the PanCan screening trial were used, these include 17 nodules proven to be cancer and 17 nodules that resolved on follow-up scans. The comparison of classification ability of features from nodules without edge vs. nodules with edge pixels reveals that the core features show better classification ability for 76 out of the 136 calculated features.
Performing a leave-one-out LDA classifier cross-validation approach in using core features, gives an accuracy of 76% with only 1 feature through 3 features, and 82% with 4 features. However, repeating the same experiment for core plus edge features, shows accuracy of 67% with only 1 feature, 73% with 3 features, 79% with 4 features. Normalizing the core texture features by the texture features of the mirrored region in the opposite lung shows an improved classification ability for 52 out of the 89 texture features.
8eea62084ca7e541d918e823422bd82e Conclusion
In this study, the results suggest using the nodule core improves feature classification as does normalizing of the nodule by the mirrored region in opposite lung.
6f8b794f3246b0c1e1780bb4d4d5dc53
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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
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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): John Mayo
- 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.
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