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Alvaro Agusti



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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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      MA03.11 - Trained Dogs Can Identify Malignant Pulmonary Nodules in Exhaled Gas (ID 13056)

      11:35 - 11:40  |  Author(s): Alvaro Agusti

      • Abstract
      • Presentation
      • Slides

      Background

      After our recent report that trained dogs can identify the presence of lung cancer (LC) in exhaled air samples of patients with and without large LC(1), we designed a prospective controlled study to investigate if such trained dog can also discriminate between the exhaled gas samples of individuals with and without malignant pulmonary nodules.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We collected samples of exhaled air from 30 patients with indeterminate pulmonary nodules before the diagnostic and therapeutic surgery, and from 77 individuals without LC and without pulmonary nodules. Exclusion criteria were other neoplasm, and chemotherapy treatment. Participants refrained to eat, drink and smoke 30 minutes before they exhaled inside a crystal tube filled with hidrophilic and hidrophovic wool and closed with silicon taps, as we used in our previous report. Likewise, the training method of the dog was also based on a progressive prize-dependent learning method. Tubes containing the samples were introduced in wood boxes with an open side to enable the smelling of the sample. The dog was confronted to samples with and without pulmonary nodules in a proportion of 1/4 in order to discriminate malignant ones.

      4c3880bb027f159e801041b1021e88e8 Result

      The dog was confronted with 90 samples with indeterminate pulmonary nodules (3 per patient) and 372 samples without pulmonary nodules and without LC. The dog was confronted 10 times to each sample of pulmonary nodules with different combinations of “no LC” exhaled gas samples, which represents a total of 900 attempts. The dog must mark the samples he identifies as malignant ones. He achieved successful results with a sensitivity of 0,97, a specificity of 0,99, a PPV of 0,97 and a PNV of 0,99. Out of 30 patients with indeterminate pulmonary nodules the dog recognized 27 of them as positive for LC and 3 as negative for LC. Those results matched with the anatomical pathology surgery report.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Trained dogs can discriminate the presence of malignant pulmonary nodules from exhaled gas samples with an extraordinarily high degree of reliability.

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    P3.11 - Screening and Early Detection (Not CME Accredited Session) (ID 977)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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      P3.11-16 - Comparative Analysis of Health-Care Resources and Economic Costs of Lung Cancer Patients Treated Medically or Surgically in Catalunya (ID 14023)

      12:00 - 13:30  |  Author(s): Alvaro Agusti

      • Abstract
      • Slides

      Background

      To contribute to the debate about the cost-benefit ratio of lung cancer computerized tomography (CT) screening programs, and to support the implementation of large scale lung ancer (LC) screening programs to increase the number of potential LC patients that can benefit from this treatment.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Observational, comparative, retrospective study includes 13.415 patients who were diagnosed of LC between 2014 and 2016 in Catalunya. All of them were treated medically or surgically. We obtain information from the data bases of the “Health attention area. Information and knowledge unit.” of the following variables (both before and after LC diagnosis): vital status and autonomy level, drug dispensation, radiotherapy sessions, use of health-care resources, day-hospital visits, hospitalization events, use of nursing homes, non-urgent sanitary transport, monthly and annual costs (€) per patient (and 3 year/survival)

      Variables were compared between the group medical treatment vs. the group surgical treatment using unpaired parametric tests. Since this is an observational study, no formal calculation of sample size was pretended. Yet, post-hoc results identified a cohort of 13.415 participants, which should be enough for descriptive purposes.

      4c3880bb027f159e801041b1021e88e8 Result

      3 year/Survival after LC diagnosis was much higher in surgical patients (78,9% vs 23,3%) (p<0.001). Surgically treated patients achieve a higher level of autonomy earlier before diagnosis.

      The monthly rate of total drug dispensation, cancer drugs, radiotherapy sessions, opioid and analgesic dispensation before and after LC diagnosis were much higher in medical patients. The rate of dispensation of ansiolitic, sedatives and anti-depressives were similar in both groups.

      Hospitalization events were slightly higher in the surgical group. There were no significant differences between groups in the rate of primary care or hospital outpatient clinic visits. The use of Health-care resources and non-emergency sanitary transport peaked before diagnosis to a larger extend in medical patients.

      The average annual cost of medical and surgical patients one year after LC diagnosis and treatment was 67% higher in medical patients (17.495 vs. 10.447 €).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Surgical treatment of LC offers better clinical outcomes and is cost-efficient. These arguments support the implementation of large scale LC screening programs to increase the number of potential LC patients that can benefit from this treatment.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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