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Wei Wang



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    P1.15 - Treatment in the Real World - Support, Survivorship, Systems Research (Not CME Accredited Session) (ID 947)

    • 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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      P1.15-32 - Real World EGFR Mutation Profile from 1699 Non-Small Cell Lung Cancer Patients in Eastern China (ID 12526)

      16:45 - 18:00  |  Presenting Author(s): Wei Wang

      • Abstract
      • Slides

      Background

      The EGFR mutation frequency and mutation types had significant geographic differences. The purpose of this study was to evaluate prevalence, clinical characteristic in eastern China which has not been reported.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      From March 2016 to March 2018 who were newly diagnosed or postoperative recurrence NSCLC received EGFR mutation detect were included analysis. Commercially available ARMS-PCR kits were used to detect EGFR mutations.

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 1699 consecutive NSCLC patients included in our study. The median age was 64 years (range 23-91), with 892 (52.5%) were male and 807 (47.5%) male. There were 852 (50.2%) with EGFR mutations out of 1699 patients in the total population. EGFR mutations were more frequent in female (64.9%) patients than in males (36.8%). Considering the frequency of mutations according to histology, adenocarcinomas (835/1495, 55.9% ) show mutations more often than squamous carcinoma (4/142, 2.82%), other NSCLC histology (13/62, 21.0%). The rate of EGFR mutation in total was lower in biopsy specimen (246/613, 40.1%) than in surgical specimen (557/993, 56.1%) or cytology specimen(49/93, 52.69%). A total of 755 (88.6%) harboring a common EGFR mutation were identified: among the 755, the most EGFR mutation type was the point mutation L858R at 21 exon (49.5%), followed by exon 19 deletion (39.1%). Ninety-seven (11.48%) patients harboring uncommon EGFR mutation, the exon 20 INS (34.0%) was the most frequently observed mutation among the uncommon EGFR mutations. The detailed EGFR mutation type were show in table1.

      Table1. The detailed EGFR mutation type

      Mutation type

      Case number

      Percentage of all cases

      Percentage of uncommon mutation

      common mutation

      L858R

      422

      49.53%

      19-del

      333

      39.08%

      uncommon mutation

      20-Ins

      33

      3.87%

      34.0%

      L858R/T790M

      18

      2.11%

      18.6%

      G719X

      14

      1.64%

      14.4%

      L861Q

      11

      1.29%

      11.3%

      G719X/S768I

      5

      0.59%

      5.2%

      L858R+S768I

      5

      0.59%

      5.2%

      S768I

      4

      0.47%

      4.1%

      19-del/T790M

      3

      0.35%

      3.1%

      G719C

      1

      0.12%

      1.0%

      L858R/19-del

      1

      0.12%

      1.0%

      L858R/20-Ins

      1

      0.12%

      1.0%

      T790M

      1

      0.12%

      1.0%

      EGFR: Epidermal growth factor receptor.

      8eea62084ca7e541d918e823422bd82e Conclusion

      In our eastern China cohort, the most common EGFR mutation was L858R, differing from previous reported data in Asian population describing 19 deletion was the most common EGFR mutation. The frequency of EGFR mutations in biopsy specimen population was lower than both in surgical specimen and cytology specimen.

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    P1.17 - Treatment of Locoregional Disease - NSCLC (Not CME Accredited Session) (ID 949)

    • 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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      P1.17-09 - V30 May Better Predict Radiation Pneumonitis After Intensity-Modulated Radiation Therapy for Lung Cancer (ID 13780)

      16:45 - 18:00  |  Author(s): Wei Wang

      • Abstract
      • Slides

      Background

      V20 and MLD are the most commonly used dose constraints for radiation pneumonitis (RP) prediction. However, intensity-modulated radiation therapy (IMRT) has unrestricted beam arrangements, an infinite number of very different dose distributions could be generated in the lung volume outside the planning target volume (PTV). Conventional dose constraints from traditional 3D conformal RT may not be valid for IMRT treatment. We hypothesize that lung dosimetric parameters may have different RP predictive values from that of traditional constraints (largely generated from 3D treatment) in IMRT treated lung cancer patients.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We retrospectively enrolled184 IMRT treated lung cancer patients from January 2014 to October 2017. The primary endpoint was acute grade 2 or higher symptomatic radiation pneumonitis (RP2), based on the National Cancer Institute’s Common Terminology Criteria for Adverse Events (version 4.03). Vdose (from V5 to V50) and MLD were generated from the lung volume outside PTV. Univariate and multivariate logistic regression analysis was used to evaluate the association between the dose parameters outside PTV to RP2. We employed area under the curve (AUC) for the receiver operating characteristic curve (ROC) to assess prediction accuracy for the single or multi-variate model.

      4c3880bb027f159e801041b1021e88e8 Result

      26 out of 184 lung cancer patients (14.1%) developed RP2 within 3 months after the end of IMRT treatment. In univariate logistic regression, although none of the clinical parameters was significantly associated with RP2, female gender (P=0.051) and chemotherapy (P=0.151) had a trend of correlation. V5 (P=0.007), V10(P=0.012) V20 (P=0.004), V30 (P=0.003) and MLD (P=0.004) were significantly associated with RP2 incidence. From ROC curve, the largest AUC of 0.67 was generated from V30, which showed a better predictive value compared with other dosimetric factors. Multivariate logistic regression analysis showed the only significant dosimetric factor is V30 (P=0.021). Combining gender and chemotherapy factors, V30 has an AUC of 0.71 which is the largest among all the other dosimetric factors.

      8eea62084ca7e541d918e823422bd82e Conclusion

      For IMRT treated lung cancer patients, V30 generated from lung volume outside PTV may predict RP more accurately than traditional dosimetric parameters.

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      P1.17-20 - Excluding PTV From Lung Volume May Better Predict Radiation Pneumonitis For IMRT Treated Lung Cancer Patients (ID 12051)

      16:45 - 18:00  |  Author(s): Wei Wang

      • Abstract
      • Slides

      Background

      Lung dose-volume histogram(DVH) could be calculated from multiple normal lung definitions. These dose differences have a direct impact on lung cancer radiotherapy treatment planning. Earlier study from 3D conformal radiation therapy suggested dose computation from total normal lung excluding gross tumor volume (GTV) may be more accurate than that of excluding planning target volume (PTV). It is unclear which definition should be used to more accurately predict radiation pneumonitis (RP) in lung cancer patients treated with intensity-modulated radiation therapy (IMRT). We aim to determine a superior normal lung volume to more accurately predict symptomatic RP in lung cancer patients treated with IMRT.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      This is a retrospective study. All patients treated with IMRT with at least 3 months follow-up are eligible. The normal lungs are defined by total lung volume excluding GTV, PTV or directly using the total lung volume. V5, V20, and MLD have been extracted for all three definitions. RP was diagnosed and graded according to the National Cancer Institute’s Common Terminology Criteria for Adverse Events, version 4.03. The primary endpoint was grade 2 or higher RP (RP2). Correlation between RP2 and dose parameters were analyzed by logistic regression. We compared RP prediction performance of each lung volume using area under the receiver operating characteristic curve (AUC).

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 184 consecutive patients treated between January 2014 and October 2017 were eligible, 26 patients (14%) developed RP2 within 3 months after treatment. Significant dosimetric difference was found between any 2-paired lung volumes (Ps<0.0001). All dose parameters from Lung-PTV method had significant correlation with RP2, with greater AUCs than the other two definitions. The best RP prediction performance was found in Lung-PTV volume MLD (AUC=0.649), which is significantly better than Lung-GTV volume MLD (AUC=0.611, P=0.006).

      8eea62084ca7e541d918e823422bd82e Conclusion

      There were significant dosimetric differences from various normal lung definitions. Excluding PTV method may accurately predict acute symptomatic radiation pneumonitis for IMRT treated lung cancer patients.

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    P2.01 - Advanced NSCLC (Not CME Accredited Session) (ID 950)

    • 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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      P2.01-124 - SIB-IMRT in Symptomatic Brain Metastases for NSCLC: A Randomized Controlled Study of WBRT Comparing 25Gy and 30Gy (ID 11955)

      16:45 - 18:00  |  Author(s): Wei Wang

      • Abstract
      • Slides

      Background

      Intensity Modulated Radiation Therapy with Simultaneous Integrated Boost (SIB-IMRT) can better control intracranial local control rate and even prolong overall survival in non-small cell lung cancer (NSCLC) patients with brain metastases. However, some patients suffer severe neurocognitive dysfunction largely due to whole brain radiation. The purpose of this study is to explore the appropriate dose of whole brain RT when SIB-IMRT is applied.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      A total of 75 patients with symptomatic brain metastases in NSCLC were randomly divided into 25Gy and 30Gy groups with 10 fraction whole brain radiation therapy (WBRT). The tumor beds with 3 mm expansion (PGTV) were synchronously boosted to 50Gy in both groups. The primary endpoint of the study was intracranial progression-free survival (iPFS) and neurocognitive dysfunction. Secondary endpoints objective response ratio (ORR) of 1 month after treatment and overall survival (OS) were included.

      Trial registration number: ChiCTR-INR-17013204.

      4c3880bb027f159e801041b1021e88e8 Result

      There were 38 and 37 patients in 25Gy and 30 Gy groups, respectively. There was not significant differences in age, gender, performance status and number of brain metastasis between these groups (all Ps>0.05). The median follow-up is 15 (range 2-39) months. The median iPFS was 11 months (95%CI:8.7-13.3) in the 25Gy Group and 8 months (95%CI:4.4-11.6) in the 30Gy Group (P=0.104). The median OS was 13 (95%CI:11.4-14.6) months in the 25Gy Group, which is significantly better than 8 (95%CI:4.4-11.6) months in the 30Gy Group (P=0.025). The mini-mental state examination(MMSE)of neurocognitive dysfunction found significant differences in the 25Gy Group vs. 30Gy Groups, 27.4±1.26 vs. 26.4±2.03 (P=0.027) at 12 months after radiotherapy (Table 1).

      Table 1. MMSE score statement

      Treatment arms

      P value

      25Gy group

      30Gy group

      Before radiotherapy

      28.03±1.57

      27.56±2.55

      0.322

      1-month After radiotherapy

      28.29±1.33

      27.92±2.13

      0.228

      3-monthAfter radiotherapy

      28.12±1.01

      27.98±1.24

      0.323

      6-month After radiotherapy

      27.47±1.55

      27.29±1.49

      0.061

      12-month After radiotherapy

      27.40±1.26

      26.37±2.03

      0.027

      Abbreviations: MMSE = mini mental state examination.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Based on this small randomized study, the 25Gy group with SIB did not reduce iPFS, but significantly improved OS and decreased toxicity of neurocognitive dysfunction at 12 months after radiotherapy, compared to the 30Gy group with 10 fractions SIB-IMRT in patients with NSCLC with symptomatic brain metastases.

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    P2.17 - Treatment of Locoregional Disease - NSCLC (Not CME Accredited Session) (ID 966)

    • 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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      P2.17-30 - Serum Lipoprotein(A) Correlates with the Effect of Endostar Combined with Concurrent Chemoradiotherapy in Patients with Locally Advanced LSCC (ID 11872)

      16:45 - 18:00  |  Author(s): Wei Wang

      • Abstract
      • Slides

      Background

      The role of vascular targeting combined with concurrent chemoradiotherapy has produced many inconsistent results in locally advanced non-small cell lung cancer, especially in Lung squamous cell carcinoma [LSCC]. Lipoprotein(a) [Lp(a)] may be critical in development of tumor angiogenesis and its levels are individualized and determined genetically. The study aimed to determine whether Lp(a) is correlated with therapeutic effects of recombinant human endostatin [Endostar] combined with concurrent chemoradiotherapy for locally advanced LSCC.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Patients with locally advanced LSCC concurrent chemoradiation therapy in our hospital from December 2007 to December 2017 were retrospectively analyzed. Patients were divided into two groups: 1) Chemoradiotherapy group [CRT group] which received weekly vinorelbine (12.5mg/m2) / carboplatin (AUC=2) concurrently with radiotherapy 60 Gy in 30 daily treatments, and 2) Endostar combination with chemoradiotherapy group (ECRT group) which received Endostar intravenous drip 1-14 days (every three weeks) concurrently with CRT. Fasting venous blood samples were collected before the treatment for The measurement of serum Lp(a) level in all patients, the effect of Endostar was assessed by stratified analysis.

      4c3880bb027f159e801041b1021e88e8 Result

      94 patients were recruited in this study. There were 59 cases in CRT group and 35 cases in ECRT group. Overall, the median progression-free survival was 9.6 vs. 14.2 months (P=0.067) with overall survival 15.0 vs 20.6 months (P=0.114), in CRT and ECR groups respectively. The median of Lp(a) was 218mg/l. In patients with serum Lp(a) less than 218mg/l, the median PFS was 10.0 vs. 9.4 months (P=0.406) and OS was 15.4 vs. 16.3 months [P=0.958], in CRT and ECR groups, respectively. However, in patients with serum Lp(a) higher than 218ng/ml, the median PFS was 9.0 vs. 15.2 months [P=0.011] and OS was 14.0 vs. 21.1 months [P=0.055], in CRT and ECR groups, respectively. Patients with Grade 3 and above AE were observed in 32.2% vs. 34.3% (P=0.658) in CRT vs. ECR groups respectively.

      figure 1.tif

      8eea62084ca7e541d918e823422bd82e Conclusion

      The serum concentration of Lp(a) may serve as a biomarker to identify the patients who would benefit from Endostar treatment with concurrent chemoradiotherapy in stage III LSCC. Perspective study is needed to validate this finding.

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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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      P3.01-68 - Early SBRT to the Primary Tumor May Overcome the Icotinib Resistance in Patients with Advanced NSCLC Harboring EGFR Mutations (ID 11985)

      12:00 - 13:30  |  Author(s): Wei Wang

      • Abstract

      Background

      Icotinib resistance is common in first-line setting for non-small-cell lung cancer (NSCLC) harboring EGFR mutations in China. It has been reported that 47% of EGFR-TKI drug resistance was from the primary tumor, 32.6% the primary and distant, and only 20.4% was distant alone (JTO, 2015). We hypothesized that effective local radiation to the primary tumor will delay Icotinib resistance. This study aimed to investigate the safety and efficacy of primary tumor stereotactic body radiotherapy (SBRT) in combination with the first-line Icotinib therapy in advanced NSCLC patients harbouring EGFR mutations.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      This is a prospective pilot study (ChiCTR-OIN-17013920) from a single institution. Eligible patients included pathologically confirmed primary NSCLC with 19/21 EGFR mutation. Patients have to have no disease progression, i.e. stable disease or partial response after one month of Icotinib treatment (125 mg, three times daily). Stereotactic body radiotherapy (SBRT) was given to the primary tumor, using 50Gy/5F or 60Gy/8F for peripheral and central primary, respectively. The primary endpoint was progression free survival (PFS). The adverse events (AEs) were assessed.

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 20 patients were enrolled between September 2016 and March 2018. Median age was 69 years (range 62-80). There were 9 males and 11 females. The baseline KPS was scored above 70 in 18 patients, 60 in 2 patients. Sixteen patients had stage IV disease and 4 had IIIb. There were 11 patients with 19Del and 9 patients with L858R mutations. After a median follow-up time of 10.4 months (range 3-19.3),only one patient had disease progression around the treated primary tumor. Nine patients had disease progression distantly outside of radiated region. Median PFS was 15.2 (95% CI 8.5-21.9) months for the whole cohort. At 10 months of follow-up, the rates of OS, PFS, local and distant PFS were 100%, 67.2%, 100% and 67.2% respectively. There were no acute or late grade 3+ treatment related toxicities.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Early primary tumor SBRT improved primary tumor control without causing serious side effects. SBRT may delay the development of icotinib resistance in patients with advanced NSCLC harboring EGFR mutations. Randomized study is needed to determine whether early SBRT can improve PFS and over survival.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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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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      P3.11-26 - Results of Initial Low-Dose Computed Tomographic Screening for Lung Cancer from a Single-Institution in China (ID 12841)

      12:00 - 13:30  |  Presenting Author(s): Wei Wang

      • Abstract
      • Slides

      Background

      Lung cancer screening using low-dose computed tomography (LDCT) has been reported to reduce lung cancer-specific mortality for smokers at high risk in patients of the United States. However, there are very few LDCT screening results from Chinese patients. We here report the screening findings at the initial round of LDCT screening program from a single-institution population-based cohort in China.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We conducted a retrospective study of a single-institution population-based LDCT screening program for lung cancer. Patients participated LDCT in Taizhou Hospital of Enze Medical Center were eligible. All noncalcified nodules with long-axis diameters of 4mm or greater in the axial plane were considered to be positive for potential lung cancer according to NLST definition. If more than three nodules were found, one dominant nodules were selected for this analysis.

      4c3880bb027f159e801041b1021e88e8 Result

      From July 2017 through December 2017, a total of 8611 participants with LDCT screening were included in this report. A total of 78 participants with history of cancer and 437 participants were follow-up procedures were excluded in this analysis. Of the remaining 8096 participants, the median age was 51 years (range, 16-97 years). A total of 1516 (18.8%) participants were younger than 40 years, 5264 (65.2%) were 40-64 years and 1316 (16.3%) were greater than 64 years. The total proportion of positive nodules was 21.8%, slightly higher in females (535/2258, 23.7%) than males (1233/5838, 21.1%). Lung cancer was diagnosed in 26 participants (0.32%) (11 males and 14 females) of the 1768 positive nodules. The comprehensive demographics of 26 lung cancer patients (included one patients with multiple metastases tumor from pancreas) is shown table 1.

      Table 1 Comprehensive demographics of 26 lung cancer patients

      No.

      Sex

      Age

      (y)

      Smoking

      Type of nodules

      Histology

      Type of EGFRm

      TNM

      Treatment

      1

      M

      70

      Never

      8mm GGN, RUL

      ADC in situ

      Wild

      pT1isN0M0

      Wedge resection

      2

      M

      47

      Current,

      40 pack-year

      16mm solid, RUL

      ADC

      19-del

      pT1aN0M0

      Lobectomy

      3

      M

      70

      Never

      Multiple nodules;

      12mm solid, RLL

      Metastatic ADC from pancreas

      unknown

      pT1bN0M0

      without

      4

      M

      53

      Current,

      60 pack-year

      21mm sub-solid, LLL

      ADC

      unknown

      pT1cN0M0

      Lobectomy

      5

      M

      49

      Never

      6mm GGO, RLL

      ADC

      L858R

      pT1aN0M0

      Wedge resection

      6

      M

      62

      Former,

      45 pack-year

      30mm, LLL

      SCC

      unknown

      cT2aN2M0

      chemotherapy

      7

      M

      62

      Former,

      24pack-year,

      32mm solid, RLL

      ADC

      19-del

      pT4N0M0

      Lobectomy

      8

      F

      44

      Never

      12mm GGO, LUL

      ADC

      unknown

      pT1bN0M0

      Segmental Resection

      9

      F

      68

      Never

      8mm GGO,RML

      ADC

      unknown

      pT1aN0M0

      Lobectomy

      10

      M

      74

      Current,

      60 pack-year

      14mm solid, RUL

      ADC

      L858R

      pT1aN0M0

      Wedge resection

      11

      M

      74

      Former,

      40 pack-year

      15mm sub-solid, LLL

      SCC

      unknown

      pT1bN2M0

      Lobectomy

      12

      F

      55

      Never

      12mm GGN, RUL

      ADC

      unknown

      pT1aN0M0

      Lobectomy

      13

      F

      64

      Never

      11mm GGO,RUL

      8mm GGO, RUL

      ADC

      ADC

      Wild

      pT3N0M0

      Lobectomy

      14

      F

      78

      Never

      18mm solid, RLL

      ADC

      19-del

      cT1bN0M0

      Gefitinib

      15

      F

      67

      Never

      14mm GGO, RUL

      12mm GGO, RUL

      ADC;

      ADC

      unknown

      pT3N0M0

      Lobectomy

      16

      F

      73

      Never

      18mm GGO, LUL

      ADC

      unknown

      pT1bN0M0

      Wedge resection

      17

      M

      75

      Never

      10mm sub-solid, RUL

      ADC

      unknown

      pT1aN0M0

      Lobectomy

      18

      M

      71

      Current,

      60 pack-year

      30mm solid, LLL

      NSCLC

      unknown

      cT2aN2M

      Lobectomy

      19

      F

      60

      Never

      8mm solid, RLL

      ADC

      19-del

      pT1aN0M0

      Lobectomy

      20

      F

      78

      Never

      17mm solid, RUL

      ADC

      L858R

      pT1bN0M0

      Wedge resection

      21

      F

      56

      Never

      11mm GGN,RUL

      ADC

      unknown

      pT1bN0M

      Lobectomy

      22

      F

      58

      Never

      13mm solid, RUL

      ADC

      L858R

      pT1bN0M0

      Lobectomy

      23

      F

      46

      Never

      13mm sub-solid, LUL

      ADC

      Wild

      pT1bN0M0

      Lobectomy

      24

      M

      65

      Current,

      40 pack-year

      50mm solid, LUL

      SCC

      unknown

      pT3N0M0

      Lobectomy

      25

      F

      67

      Never

      9mm solid, RUL

      5mm solid, RUL

      ADC;

      ADC in situ

      L858R

      pT3N0M0

      Wedge resection

      26

      F

      47

      Never

      7mm GGO, RUL

      ADC

      20-INS

      pT1bN0M0

      Wedge resection

      GGO=Ground-glass opacity; GGN=ground glass density nodule; RML=right middle lobe; RLL=right lower lobe; RUL=right lower lobe; LUL=left upper lobe; LLL=left lower lobe; tis=carcinoma in site; EGFRm= EGFR mutation

      8eea62084ca7e541d918e823422bd82e Conclusion

      The overall rate of positive nodules is similar to previous reports, and the overall cancer detection rate by LDCT in our cohort was lower than previous reports from others (0.36-3.3%).

      6f8b794f3246b0c1e1780bb4d4d5dc53

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