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Sudhir Sundaresan



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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  |  Author(s): Sudhir Sundaresan

      • Abstract
      • Slides

      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.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P2.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 965)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.16-50 - Do Patients Have Preconceived Ideas on Various Surgical Approaches? Patient Perspective: Open vs. Minimally Invasive Surgery (PROMIS) Survey. (ID 14398)

      16:45 - 18:00  |  Author(s): Sudhir Sundaresan

      • Abstract
      • Slides

      Background

      Patient perspectives on minimally invasive (MIS) versus open surgical approaches have not been well studied. Health care workers often presume that patients prefer MIS. The aim of this survey was to objectively document patient viewpoints on pain, complication risks, cosmesis, travel burden, and functional outcomes throughout the course of treatment.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      From 2012-2017, of the 206 consented patients, 184 lung and esophageal surgical patients were prospectively enrolled in this observational cohort study. Participants were asked to complete a RAND36 short form health survey (SF-36), which measures functional outcomes. They also completed the PROMIS questionnaire, which measures expectations regarding travel burden, pain, complications, and cosmesis on a continuous visual analog scale (VAS). The PROMIS questions were also classified into three anatomic regions (neck, chest, and abdomen). Patients were surveyed pre-operatively, at 1 month and at 6 months. McNemar’s test, and paired and independent t-test were used as appropriate.

      4c3880bb027f159e801041b1021e88e8 Result

      Of 206 patients, 184 (89%) completed the survey at least once. SF-36 showed physical functioning, role limitations due to physical health, energy level, pain, and social functioning worsened significantly at 1 month. All indices recovered to baseline at 6 months. Recovery of indices was similar in both MIS and open surgery patients. Patients indicated that pain after surgery (mean VAS = 7.3; 95% CI 6.9-7.6) was more important than size of incision (mean VAS = 4.5; 95% CI 3.9-5.1, p < 0.001) and travel burden (mean VAS = 4.0; 95% CI 3.4-4.5, p < 0.001). The risk of complications (mean VAS = 7.5; 95% CI 7.2-7.9) was more important than size of incision (mean VAS = 4.5; 95% CI 3.9-5.1, p < 0.001) and travel burden (mean VAS = 4.0; 95% CI 3.4-4.5, p < 0.001). These findings were similar at each time point and across each body regions. The MIS group perceived pain following surgery (mean VAS = 7.12; 95% CI 6.35-7.89) was more important than the open group though it was not statistically different (mean VAS = 6.02; 95% CI 5.25-6.79, p = 0.07).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Early postoperative deterioration followed by 6-month recovery in functional outcomes was reported by all patients regardless of surgical approach (MIS vs. open). Complication risk and pain after surgery were perceived as more important than size of incisions and distance traveled for treatment. Patients maybe more open-minded to participation in trials comparing MIS to open surgery than expected.

      6f8b794f3246b0c1e1780bb4d4d5dc53

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.