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Jacob M Sands



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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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      MA03.06 - Descriptive Epidemiology of Significant Incidental Findings in a Large Clinical Lung Cancer Screening Program (ID 12313)

      11:05 - 11:10  |  Author(s): Jacob M Sands

      • Abstract
      • Presentation
      • Slides

      Background

      The identification and reporting of significant incidental (non-lung cancer) findings in CT lung screening (CTLS) has not been standardized, though there is an available modifier in the LungRADS structured reporting system to identify a scan as including a significant incidental finding. In this study, we describe the significant incidental findings and follow-up in a large, established clinical CTLS program.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We retrospectively reviewed all of the clinically significant or potentially significant non-lung cancer findings, which we will refer to as significant incidental findings, for patients undergoing clinical CTLS in our program from January 2012 through December 2016 with follow-up through December 2017. Significant incidental findings were defined as any unexpected new and/or unknown non-lung cancer finding requiring clinical or imaging evaluation prior to the next CTLS exam. Given the high prevalence of coronary artery calcifications and emphysema in the CTLS population, these findings were not classified as signifi­cant incidentals. We describe the site of the incidental finding, the follow-up intervention, and the outcome. We also calculate the cancer detection rate for non-lung cancers.

      4c3880bb027f159e801041b1021e88e8 Result

      Of the 6482 scans performed during the study window, 286 (4.4%) reported a significant incidental finding. These findings were reported in 276 (9.4%) of the 2927 patients screened during that time. Nine patients had more than one CTLS exam with a significant incidental finding. The majority of incidental findings were found in the kidneys (18%), liver (14%), and thyroid (11%). There were 15 non-lung cancers diagnosed for a cancer detection rate of 5.4%. The most common intervention, 43%, involved additional imaging, while 26% had a follow-up phone call or consult with a physician. Biopsy was performed in 9.1% and 6.7% had surgery. Surveillance was recommended for 43.4% of the findings, medical intervention was required for 12.3% of non-cancer findings and 12.9% of findings required no additional follow-up. There were 25 (8.7%) significant incidental findings with unknown follow up and outcomes and 31 (10.8%) that resulted in not finding anything on follow-up to explain the finding seen on the CTLS.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Only 4.4% of all scans in our CTLS program reported a significant incidental finding. Almost 70% of the 286 significant incidental findings identified conditions requiring medical treatment, surgical intervention, or surveillance. There was one non-lung cancer diagnosis for every 7.5 lung cancers diagnosed in our screening program.

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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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      P1.11-02 - Pathologic Comparison of Prevalent vs. Incident CT Lung Screen Detected Cancer in NCCN High-Risk Subjects: Are They Different? (ID 13518)

      16:45 - 18:00  |  Author(s): Jacob M Sands

      • Abstract

      Background

      CT lung screening (CTLS) detects two overlapping but potentially distinct groups of tumors. Prevalent tumors, found at baseline screening, are thought to be enriched with slow-growing, potentially indolent cancers while incident tumors, found on annual repeat scans, are thought to be more uniformly fast-growing and aggressive. Pathologically, squamous cell carcinomas, small cell carcinomas (SCC) and large cell neuroendocrine carcinomas (LCNEC) are uniformly fast-growing and aggressive while adenocarcinomas are more heterogenous in their growth-rates, behavior and histology. By comparing pathologic subtypes, I-ELCAP investigators reported a higher frequency of adenocarcinomas compared to squamous cell carcinomas in prevalent compared to incident tumors (ratio 8:1 vs. 3.4:1) and conversely a 4-fold lower frequency of SCC/LCNEC (7% vs. 30%, respectively). Based partly on these data, some worry about the risk of overdiagnosis in CTLS subjects undergoing baseline screening in which the proportion of slow-growing potentially indolent adenocarcinomas may be enriched. Current guidelines recommend screening specific high-risk subjects for which pathologic comparisons of prevalent and incident cancers have not been thus far described.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      The pathology of 134 CTLS cancers detected at Lahey Hospital & Medical Center was reviewed, including 93 detected at baseline and 41 at annual repeat screening. All individuals met the NCCN Guidelines Lung Cancer Screening v1.2012 high-risk criteria, were asymptomatic, had no known metastatic disease and were free of lung cancer for at least 5-years. Detailed pathologic analysis was performed for 65 stage I resected adenocarcinomas whereas lineage alone was determined for the cytologically diagnosed tumors.

      4c3880bb027f159e801041b1021e88e8 Result

      The proportion of adenocarcinomas to squamous cell carcinomas was similar in prevalent compared to incident tumors (ratio 2.6:1 vs. 3.1:1). Small cell carcinomas were only half as frequent among prevalent vs. incident cancers (5% vs. 12%). Among stage I adenocarcinomas, a similar proportion of prevalent vs. incident cancers exhibited a ≥5% solid pattern (32% vs. 30%), ≥5% micropapillary pattern (23% vs. 22%), ≥10% cribriform pattern (30% vs. 26%), intermediate/high mitotic grade (57% vs. 57%), angiolymphatic invasion (43% vs. 48%), and STAS (36% vs. 39%). Visceral pleural invasion was actually higher in the prevalent cancers (27% vs. 17%) however no statistically significant differences were observed.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Pathologic comparison of prevalent vs. incident CTLS cancers among NCCN defined high-risk subjects reveals less variability than previously described by I-ELCAP. In particular, histologically indolent adenocarcinomas are not enriched in prevalent compared to incident tumors and thus the risk of overdiagnosis in baseline detected cancers may be less than once thought.

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