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Deepali Jain



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    MA01 - Early Stage Lung Cancer: Questions and Controversies (ID 894)

    • Event: WCLC 2018
    • Type: Mini Oral Abstract Session
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 10:30 - 12:00, Room 202 BD
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      MA01.04 - Discussant - MA01.01, MA01.02, MA01.03 (ID 14572)

      10:45 - 11:00  |  Presenting Author(s): Deepali Jain

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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    P1.05 - Interventional Diagnostics/Pulmonology (Not CME Accredited Session) (ID 937)

    • 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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      P1.05-11 - Role of EBUS-TBNA in Evaluation of Mediastinal Lymphadenopathy and Masses in Patients with Known or Suspected Extra-Pulmonary Malignancies (ID 11907)

      16:45 - 18:00  |  Presenting Author(s): Deepali Jain

      • Abstract
      • Slides

      Background

      Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) has recently emerged as a minimally invasive and safe modality for the evaluation of mediastinal lymphadenopathy, particularly in staging of lung carcinoma patients. Our aim was to evaluate its utility in patients with non-pulmonary malignancies presenting with mediastinal lymphadenopathy.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      A computerized database search was performed for all EBUS-TBNA aspirations performed from 2015 to 2017 on patients with known or suspected extra-pulmonary malignancy and presence of mediastinal lymphadenopathy and/or masses on imaging. All archived cytology material was reviewed and categorized as positive, negative and unsatisfactory. Follow-up histology samples served as comparison standard.

      4c3880bb027f159e801041b1021e88e8 Result

      One-hundred-twenty-one patients were included. In 99 patients with known malignancy, primary sites were in the head and neck (25%), breast (22%), female genital tract (9%), lower gastrointestinal (GI)-tract (8%), genitourinary tract (7%), and upper GI-tract (5%). Six patients had history of hematolymphoid malignancy while primary site or type of malignancy was unknown in the remaining (18%). EBUS-TBNA diagnosed metastases or lymphoma relapse in 48 (40%), identified new malignancy in 18 (15%), granulomatous inflammation in 15 (12%), tuberculosis in 2 (1%), reactive lymphadenitis in 21 (17%) patients and was inadequate in 17 (14%) patients. Cell block was adequate in 43% (23/53) cases and was indispensible for diagnosis in 13% (7/53) cases. Subcarinal and right paratracheal lymphnodes were most commonly aspirated (77%) while hilar and paratracheal masses of non-lymphnode origin were assessed in 10% cases. Follow-up histology samples (available only in 13 cases) showed 100% concordance with EBUS-TBNA results (no false positive or false negative cases). Two cases unsatisfactory on EBUS-TBNA were positive for malignancy on histology.

      8eea62084ca7e541d918e823422bd82e Conclusion

      EBUS-TBNA is a highly efficient modality for the evaluation of mediastinal lymphnodes and masses in patients with extra-pulmonary malignancies with an overall diagnostic yield of 86%.

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    P1.09 - Pathology (Not CME Accredited Session) (ID 941)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 2
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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      P1.09-03 - Challenges in PD-L1 Immunoexpression in Liquid Based Cytology Samples of Advanced Stage Non-Small Cell Lung Carcinomas (ID 11311)

      16:45 - 18:00  |  Presenting Author(s): Deepali Jain

      • Abstract
      • Slides

      Background

      Study of programmed death-ligand 1 (PD-L1) expression is essential in patients of advanced lung cancer to determine their eligibility and predict responsiveness for immune-checkpoint inhibitors. Lung cancer is frequently diagnosed on cytology specimens. Although PD-L1 IHC assays are validated on formalin fixed paraffin embedded (FFPE) tissue, evidences are present in literature which showed high concordance of cytology samples with paired biopsies. However liquid based cytology (LBC) processed specimens have not been tested for PD-L1 expression.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Immunohistochemistry using the anti-PD-L1 clone SP263 was performed on BD SurePath LBC processed bronchial washing and brushing smears and paired FFPE endobronchial biopsy specimens. The presence of 100 viable tumor cells was considered adequate for PD-L1 testing. Staining was interpreted positive if membranous and/or cytoplasmic protein expression at any intensity greater than background staining was detected in at least 25% of tumor cells.

      4c3880bb027f159e801041b1021e88e8 Result

      There were 26 patients with 13 adenocarcinomas and 13 squamous cell carcinomas which were diagnosed by bronchial brushings, washings and concurrently obtained endobronchial biopsy. Twelve out of total 26 biopsies showed cytoplasmic and membranous PD-L1 positivity in >25% tumor cells (46%). Corresponding LBC smear showed PD-L1 positivity in 9 cases establishing concordance of 88.4%. No negative case was positive on cytology. However, there were following challenges while interpreting PDL1 IHC on LBC processed smears: 1. Thick clusters of cells: LBC can cause rounding up of epithelial cells and create thick clusters of tumor cells. Therefore, it was necessary to see under higher magnification (40x) for proper interpretation of membrane staining. 2. Identification of tumor cells: Although identification of tumor cells was done before PD-L1 staining, after staining they were interpreted only on higher magnification to better differentiate them from alveolar macrophages. 3. PD-L1 staining in macrophages: Five cases showed very strong cytoplasmic positivity in macrophages. Since tumor cells showed cytoplasmic and membranous positivity it was easy to differentiate tumor cell positivity from macrophage positivity. Necrotic background in one case stained strongly with PD-L1 immunocytochemistry. 4. Nuclear positivity of PD-L1 positivity: One case, where corresponding biopsy was positive for PD-L1 IHC, showed aberrant nuclear positivity.

      8eea62084ca7e541d918e823422bd82e Conclusion

      PD-L1 IHC can be performed on LBC processed smears. Though there are challenges in interpretation of immunoexpression inherent to the LBC smears, they can be used in situations when histology material is not available. Future studies are needed to determine their ability to predict response to immunotherapy.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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      P1.09-11 - Immunohistochemical Assessment of BRCA1 Associated Protein-1 (BAP1) in Pulmonary Mucoepidermoid Carcinomas (ID 11322)

      16:45 - 18:00  |  Presenting Author(s): Deepali Jain

      • Abstract
      • Slides

      Background

      Primary pulmonary mucoepidermoid carcinomas (PMEC) are rare tumors that account for <1% of all lung carcinomas. They are presumed to originate from the minor salivary glands lining the tracheobronchial tree. PMEC are the most common malignant salivary gland tumors of tracheobronchial tree. Despite recent advances in diagnosis and treatment, there has not been much improvement in the outcome of patients with MECs, thus necessitating the identification of novel targeted therapeutic agents. Comprehensive genomic profiling has recently revealed genomic aberrations in BRCA1 associated protein-1 (BAP1) gene in a subset of their non-pulmonary salivary gland counterparts. We conducted this study to identify loss of BAP1 by immunohistochemistry (IHC) in a cohort of PMECs.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Cases of PMECs were retrieved from the departmental archives. Hematoxylin and eosin stained sections were reviewed. Immunohistochemistry for BAP1 was performed on formalin fixed paraffin-embedded tumor sections.

      4c3880bb027f159e801041b1021e88e8 Result

      Twenty-five PMEC cases were retrieved, out of which sufficient tumor tissue for IHC was available only in 15 PMECs. Thirteen (86.7%) tumors were tracheobronchial in location, while two (13.3%) were intraparenchymal. All were low grade MECs. On immunohistochemistry, BAP1 nuclear staining was retained in all cases (100%), irrespective of tumor location or grade.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Identification of easily applicable techniques to detect BAP1 loss in PMECs is needed for therapeutic decisions. Using IHC, loss of BAP1 staining was not seen in any of our cases, suggesting either the extreme rarity of BAP1 loss in PMEC or insensitivity of BAP1 IHC to detect aberrations at genomic level. Analysis of aberrations in BAP1 gene by genomic approaches in PMECs may be done before excluding the possibility of BAP1 gene as a predictive biomarker for targeted therapies.

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    P1.14 - Thymoma/Other Thoracic Malignancies (Not CME Accredited Session) (ID 946)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 3
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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      P1.14-12 - GTF2I Mutation in Thymomas: Indian and German Study (ID 14314)

      16:45 - 18:00  |  Presenting Author(s): Deepali Jain

      • Abstract
      • Slides

      Background

      Point mutation (L404H) of GTF2I gene on chromosome 7 has been identified in thymic epithelial tumors; most predominantly in A and AB histotypes and associated with good prognosis. The objective of this retrospective analysis was to assess the frequency of GTF2I mutation in Indian and German thymomas and correlate with WHO histotypes.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      A cohort of Indian and German thymomas of different histotypes was retrieved from the archives. Clinicopathological details were obtained from case files. Hematoxylin-eosin stained slides were reviewed and histopathological subtypes along with Masaoka-Koga staging were determined. The available blocks were selected for DNA extraction. Tumors rich in cancer cells (>50%) were evaluated for GTF2I mutation using Sanger sequencing. Primer for Exon 15 of GTF2I gene was designed using NCBI and Primer 3 (v.0.4.0) software. Results were compiled and analysed.

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 126 resection specimens were retrieved comprising 23 (18.2%) Type A, 30 (23.8%) Type AB 16 atypical A/AB (12.6%) and 30 (23.8%) Type B thymomas. Remaining 27 cases belonged to 18 thymic carcinomas, 2 sclerosing mediastinitis, 2 metaplastic thymomas, 1 thymolipoma, and 4 non-thymomatous lesions.

      Out of a total of 69 A/AB thymomas, 53 (76.8%) were positive including 88% (22/25) Indian and 65.9 % (29/44) German cases. 26% (18/69) A/AB were negative. All Indian B histotypes (n=9) were negative, whereas 4 German B thymomas (4/21; 19%) were positive for GTF2I mutation. No mutations were found in non-thymomatous pathologies.

      Among 34 Indian cases, there was equal gender distribution, median age was 48 years and 31 were in lower stage groups (Stage I and II). Clinical details and follow up available in 17 of 34 cases had a median follow up of 14 months and revealed presence of myasthenia gravis in 76.5% cases. Recurrence seen in 3 cases revealed high risk morphology (2 Type B histotypes and 1 atypical A) and one death of Type A was due to myasthenic crisis.

      8eea62084ca7e541d918e823422bd82e Conclusion

      The similarity of Indian and German (and previously published American) cohorts of A/B and type B thymomas in term of GTF2I mutation frequencies suggests a thymus-specific microenvironmental mutagenic mechanism and argues against a relevant impact of environmental or ethnic (germ line) factors. The unusually high prevalence of Myasthenia gravis among the Indian thymomas warrants further analysis to exclude referral bias.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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      P1.14-13 - PD-L1 Immuno-Expression Assay in Thymomas: A Study from India (ID 11244)

      16:45 - 18:00  |  Presenting Author(s): Deepali Jain

      • Abstract
      • Slides

      Background

      Programmed death ligand 1 (PD-L1), an immune check point inhibitor, is known to be expressed in several malignancies and is being considered as a prognostic factor and a potential immunotherapeutic target. Recent development of anti-PD-1/L1 antibodies has demonstrated anticancer activity of these agents in various neoplasms. The aim of this study was to characterize PD-L1 expression in thymomas and to determine whether PD-L1 represents a therapeutic target in unresectable thymomas. A correlation with clinicopathological features and previously published studies in the literature was established.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Tissue microarrays were prepared from selected blocks of thymomas and immunohistochemistry (IHC) using SP263 clone of PD-L1 was performed. Cases were considered as PD-L1 positive or negative based on percentage of stained thymic epithelial cells; if these were <25 or >25 percent. Results were compared clinically and with previously published studies using Google and Pubmed search engines.

      4c3880bb027f159e801041b1021e88e8 Result

      Of 84 cases of thymoma, 69 (82.1%) revealed PD-L1 positivity in more than 25% cells. 94.23% of type B thymoma subtypes (B1/B2/B3) were PD-L1 positive (P<.001). There was no correlation of PD-L1 with age, gender, myasthenia gravis, the tumor size or stage of disease. So far, 9 studies of PD-L1 expression in thymic epithelial tumors are available in the literature; most of which showed PD-L1 expression in higher stage and B histotype however percentage positivity varied from 53.7% to over 90%.

      8eea62084ca7e541d918e823422bd82e Conclusion

      PD-L1 expression is frequent in type B (B1/B2/B3) thymomas. It can be easily evaluated by IHC even on small biopsies in unresectable cases. PD-L1 immunoassay will serve as a potential indicator for benefit from anti-PD-L1 antibody immunotherapy in thymomas thereby enabling improved clinical evaluation as well as prognostic stratification of patients.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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      P1.14-14 - Histotyping of Indian Thymomas: A Comprehensive Clinicopathologic Study (ID 11242)

      16:45 - 18:00  |  Presenting Author(s): Deepali Jain

      • Abstract
      • Slides

      Background

      Thymomas are rare, but most common anterior mediastinal lesions. The WHO 2015 classification has defined criteria of classifying these into various subtypes. The histomorphologic spectrum of thymic epithelial tumors (TET) in Indian population has not been explored. We aimed to study the histomorphology of TETs in the Indian patients with clinico-pathological correlation.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      It was a retrospective, tertiary referral centre, study. All cases of morphologically confirmed, surgically resected specimens and small biopsies diagnosed as TETs since 2009 were included. Clinical details and histology slides were reviewed using the Modified Masaoka-Koga staging system and WHO 2015 classification. Clinico-pathological correlation and survival analysis was done. Comparative review from other published Indian studies was performed.

      4c3880bb027f159e801041b1021e88e8 Result

      We identified 219 cases of TETs (138 resections and 81 biopsies). Most common histo-morphologic type was B2 and most frequent stage was I. Clinically, higher stage tumors were found mostly in men (P=.008) and these were type B thymomas (P=.01). Association of myasthenia gravis was prevalent in women (P=.02) and in lower stages (P=.04). Survival analysis revealed significant association between recurrence and tumor stage. Although thymic carcinoma was diagnosed on biopsy, no resectable case was identified.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Literature lacks detailed histotyping of TETs from India. Indian thymomas are most commonly stage I tumors of B2 and AB histotypes. Resected thymic carcinomas are conspicuously absent in Indian cohort. We hope that broadening the spectrum of recognized pathologic manifestations of Indian thymomas will help global database for future studies.

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    P3.01 - Advanced NSCLC (Not CME Accredited Session) (ID 967)

    • 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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      P3.01-51 - Outcomes with Systemic Chemotherapy in Advanced  NSCLC Patients with Performance Status 2 and Above and without Driver Mutation (ID 14433)

      12:00 - 13:30  |  Author(s): Deepali Jain

      • Abstract
      • Slides

      Background

      Platinum-based combination chemotherapy is recommended as the standard treatment for patients with advanced NSCLC, but its benefit is limited to patients with performance status (PS) of 0 or 1. However, it is not clear whether these benefits apply to patients with poor performance status ((PS 2 and above)). These patients have inferior outcomes and have been excluded from clinical trials. This population accounts for a significant portion (up to 30%) of patients of our practice and some of them have been treated with systemic chemotherapy based on clinician’s discretion. We have analyzed the outcome of these patients who have been treated with chemotherapy despite poor performance status.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We performed a retrospective analysis of patients of advanced NSCLC with poor PS (ECOG PS 2 or more) registered at our lung cancer clinic between January 2016 and September 2017 and treated with systemic chemotherapy. Patients with driver mutations who were treated with first line TKIs were excluded. Hospital case records were reviewed for baseline characteristics, treatment details and outcome data.

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 78 patients were found to be eligible for this analysis. Median age was 60 years (33-77 years) including 15% patients 70 years or above. At presentation out of these 78 patients, 48 (62.5%) were smokers, 24 patients (30 %) had pleural effusion, 8 patients (10%) had brain metastasis and 30 patients (38%) had bone metastasis. Majority patients had ECOG PS 2 but 35 % had PS 3 or 4 also and 38(48 %) had one or more associated comorbidities. The most common chemotherapy regimen used was weekly paclitaxel and carboplatin (50 %) followed by pemetrexed and carboplatin (23 %). Majority (61.5 %) patients could complete 4 or more cycles of chemotherapy however 10 patients (13%) could receive only one cycle and 21 (27%) patients even received maintenance chemotherapy. Chemotherapy was interrupted or stopped due to toxicity in 33% patients. At least one point improvement in ECOG PS from baseline was observed in 44 patients (56%) after 2 cycles of chemotherapy. Objective response and disease control rates were 21 % and 48.6 % respectively. After a median follows up of 8.6 months, median progression free survival was 5.8 months.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Systemic chemotherapy in modified doses and schedules in advanced NSCLC patients with PS 2 and above is feasible and may be associated with better symptom palliation with clinical benefit and improvement in survival. Further studies addressing this neglected subgroup are indicated.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P3.09 - Pathology (Not CME Accredited Session) (ID 975)

    • 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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      P3.09-22 - Correlation Between Maximum Tumour Diameter Measurement on CT-Scan and Histopathological Specimen: An Indian Experience (ID 13431)

      12:00 - 13:30  |  Author(s): Deepali Jain

      • Abstract
      • Slides

      Background

      Lung cancer is staged according to TNM classification, which encodes the anatomic extent of the disease. This is the most important prognostic factor in patients diagnosed with lung cancer. CT scan is a basic imaging modality used for pre-treatment tumour staging (T staging). Each centimetre increase in size leads to worsening of prognosis. Adjuvant treatment decisions are based upon the final histopathological tumour size. Accurate clinical and pathologic correlation has been an important focus of research in many cancers. The objective of our study is to see for any discordance with respect to tumour size calculated by CT scan and final histopathological specimen in patients of carcinoma lung undergoing upfront surgery.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      All patients of lung cancer operated upfront between 2012 to 2017 were included in the study. Any patient with chest wall involvement, significant pleural effusion and tumours of main bronchus were excluded. CT scans were acquired from the supraclavicular region through the adrenal glands using a 1.25 mm slice thickness with 1.25 mm spacing following deep inspiration. Based on tumour perimeter maximum tumour size was calculated. The largest diameter of resected lung tumour was recorded using a standard ruler by the pathologist. A mean, median and range for both the CT diameter and pathology diameter were obtained. A paired t-test was used to examine the measurement difference between CT and pathology.

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 109 patients were included in the study. Most common histology was Squamous cell carcinoma (n=40,36%), followed by Adenocarcinoma (n=32,29.3%), Neuroendocrine tumour(n=27,24.77%) and other histologies(n=10,9.17%). Among these patients, 22 tumours were located in right upper lobe (20.18%), 10: right middle lobe(9.17%), 25:right lower lobe(22.93%), 31: left upper lobe(28.44%) and 21: left lower lobe(19.26%). The mean size of tumour on CT scan is 4.92cm (SD=1.852cm, range:1-10 cm) and mean size on grossing is 4.5cm(SD=1.774cm,range:0.5-9.5cm)(p<0.05). The difference between the CT diameter and histopathological size is statistically significant. Tumour location and histology did not add any difference to tumour shrinkage.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Our study demonstrates that there is a statistically significant difference between tumour diameter as measured by CT and its pathologic size. These differences could have implications in the treatment and prognosis of patients with lung cancer.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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