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Leslie G Dodd

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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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      P1.05-01 - Incidence and Clinical Relevance of NSCLC Lymph Node Micro-Metastasis Detected by Staging EBUS-TBNA (ID 13829)

      16:45 - 18:00  |  Author(s): Leslie G Dodd

      • Abstract


      Appropriate staging of non-small cell lung cancer (NSCLC) patients is crucial to provide accurate prognostic information and select appropriate treatment. Several publications have reported an approximate 20% incidence of occult micro-metastasis (MM) in surgically resected lymph nodes (LN) pathologically interpreted as negative by hematoxylin and eosin staining (H&E). Detection of MM was associated with worsened survival. The majority of NSCLC lymph node staging is now conducted using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). The purpose of this study is to determine the frequency of detection of occult MM in EBUS-TBNA specimens and to evaluate the impact of the presence of MM on progression-free and overall survival.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      All patients undergoing EBUS-TBNA for NSCLC lymph node staging at our institution between September 2013 and October 2017 were eligible for inclusion. Patients were identified using provider-maintained case lists, operating or procedure room electronic schedules, and tumor board patient presentations. Patients were excluded if a definitive diagnosis of NSCLC was not obtained within 3 months of the EBUS-TBNA examination or if distant metastatic disease was present at the time of diagnosis. Patient cell blocks from the EBUS-TBNA procedure were evaluated by a cytopathologist using H&E staining according to standard guidelines. Patients with N2 or N3 disease on routine cytopathology examination were excluded. Cell blocks from the included patients were sectioned into five 5 mm sections spaced at least 10 mm apart and immunohistochemistry for pan-cytokeratin was performed. The resulting slides were then reviewed for evidence of MM by a blinded cytopathologist.

      4c3880bb027f159e801041b1021e88e8 Result

      Of 887 patients screened, 44 patients were identified fitting inclusion criteria with sufficient additional tissue for testing. The mean age and smoking history were 68 ± 10 years and 45 pack-year history, respectively. The patients were majority male (61%) and Caucasian (75%). Fifty-two percent of patients were stage 1 at the time of diagnosis, 34% were stage 2, and 14% were stage 3a. Three patients (6.8%) were found to have pan-cytokeratin positive MMs. All 3 MMs detected were at N2 LN stations. The presence of MMs was associated with significantly decreased progression-free (median 210 vs. 1293 days, p=0.0099) and overall survival (median 238 vs. 1120 days, p=0.0357).

      8eea62084ca7e541d918e823422bd82e Conclusion

      LN micro-metastases can be detected during EBUS-TBNA staging examinations and are associated with poor clinical outcomes. If prospectively confirmed in a larger study, these results have significant implications for EBUS-TBNA specimen analyses and the current NSCLC staging paradigm.