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Michael Alexios Gulak
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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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P1.05-03 - Significance of Lymph Node SUVmax In Predicting Nodal Metastasis By EBUS in Lung Cancer Patients (ID 12043)
16:45 - 18:00 | Presenting Author(s): Michael Alexios Gulak
- Abstract
Background
Nodal staging of non-small-cell lung cancer (NSCLC) patients begins with imaging such as Positron emission tomography–computed tomography (PET-CT). It provides information about lymph node (LN) location, enlargement, and metabolic activity as measured by the maximum standardized uptake value (SUVmax). However, more definitive information can only be obtained by direct sampling through cervical mediastinoscopy (Med) and/or endobronchial ultrasound-guided transbronchial needle aspiration (EBUS). There remains discrepancy when comparing the diagnostic accuracy of these two methods for detecting nodal metastasis. Further, there is inadequate data on the value of SUVmax magnitude in predicting nodal metastasis by EBUS.
a9ded1e5ce5d75814730bb4caaf49419 Method
This was a retrospective analysis of 148 biopsy-confirmed NSCLC patients who underwent Med and/or EBUS for staging purposes from 2010-2015 (2013 excluded). Two groups matched by age, sex, and year of procedure were analyzed to determine if the diagnostic accuracy was comparable between the two methods. Primary tumour and LN SUVmax was correlated with the likelihood of finding LN metastasis by either method. Chi-squared tests and Student's t-tests were used to assess for significance where appropriate.
4c3880bb027f159e801041b1021e88e8 Result
The mean SUVmax of true positive LNs was significantly higher than true negative LNs sampled by EBUS (7.77 vs. 4.06, p=0.0047, t-test). Among PET-positive LNs, there was a significant correlation between likelihood of positive findings by EBUS and increased SUVmax>4 (p=0.018, Chi-squared test). There were no significant differences between Med and EBUS in sensitivity, specificity, PPV, or NPV. However, Med had significantly higher diagnostic yield (p<0.0001, Chi-squared test).
8eea62084ca7e541d918e823422bd82e Conclusion
Our results suggest that among PET-positive LNs, there is a significant correlation between SUVmax magnitude and likelihood of detecting true LN metastasis by EBUS. Additional studies should aim to further characterize this relationship.
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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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P3.11-11 - Improving Timeliness of Lung Cancer Diagnostic Services with the Implementation of Coordinated Care via a “Navigation Day” (ID 12445)
12:00 - 13:30 | Presenting Author(s): Michael Alexios Gulak
- Abstract
Background
Lung cancer patients often experience stressful wait times and delays throughout the diagnostic phase of care. In an effort to streamline this process, a multidisciplinary team at The Ottawa Hospital (TOH) created a “Navigation Day” whereby patients and their family partake in a day-long visit and receive concurrent coordinated testing. At the Navigation Day, patients have teaching, introduction to social work, access to specialist care for symptom control, and same day appointments via dedicated test slots for positron emission tomography–computed tomography (PET-CT) scans, pulmonary function tests (PFTs) and/or magnetic resonance imaging (MRI) of the head. We evaluated the impact of this program on wait times and patient satisfaction.
a9ded1e5ce5d75814730bb4caaf49419 Method
Patients with a suspicion of lung cancer on chest CT who were referred during three time periods relative to the implementation of Navigation Day were included: one year pre-launch, one year post-launch, and two years post-launch. Mean wait times for PET, PFT, and/or MRI tests were calculated for each time period. To specifically assess the impact of dedicated slots on wait times, patients within each time period were stratified according to whether they underwent their test on the same day or different day from their Navigation Day. Student’s t-test and ANOVA were used to assess for significance. Patient satisfaction was measured by examining provincially-collected data from a standardized survey used by all diagnostic assessment programs in Ontario, and data from program-specific feedback surveys distributed at TOH.
4c3880bb027f159e801041b1021e88e8 Result
At one year post-launch, mean wait times improved from 15.5 to 9.2 days for PET (p<0.0001, t-test), from 15.7 to 9.6 days for PFT (p<0.0001), and from 16.0 to 10.2 days for MRI (p<0.0001). These improvements were sustained at two years post-launch, and MRI wait time improved even further from 10.2 to 6.6 days (p<0.0001, t-test). Those patients who underwent tests within a dedicated slot experienced the shortest wait times for all tests, at 5.8 days for PET, 5.8 days for PFT, and 6.3 days for MRI (p<0.0001, ANOVA). Wait time dispersion also improved by 11.2% for PET, 10.1% for PFT, and 19.1% for MRI. Patient satisfaction in the categories of quality of care, rapidity of care, coordination of care, and being informed remained high following the implementation of Navigation Day.
8eea62084ca7e541d918e823422bd82e Conclusion
Implementation of a Navigation Day significantly improved timeliness of diagnostic services (PET, PFT, and MRI) for potential lung cancer patients. This program represents an innovative service delivery model for other lung cancer care centers.
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