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Rana Mehdi



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    P2.06 - Mesothelioma (Not CME Accredited Session) (ID 955)

    • 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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      P2.06-28 - Assessment of Chest Wall Motion Using Structured Light Plethysmography (SLP) in Mesothelioma and Benign Pleural Disease (ID 11785)

      16:45 - 18:00  |  Author(s): Rana Mehdi

      • Abstract
      • Slides

      Background

      Diagnosis of mesothelioma can be a prolonged and distressing process for patients. Non-invasive assessment of ribcage and abdominal movements is possible with structured light plethysmography (SLP) which is quick and easy to perform; we sought to assess whether changes in respiratory movements could be used to differentiate benign pleural disease from mesothelioma.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Patients attending the preoperative assessment clinic prior to diagnostic pleural biopsy were recruited prospectively. SLP was performed prior to surgery and the recordings processed by a blinded technician. Binary logistic regression was used performed based upon histology results and the model was assessed with area under the curve (AUC) analysis. Survival analysis (Kaplan Meier plot and Log Rank test) was performed to assess whether survival was different depending on SLP results.

      4c3880bb027f159e801041b1021e88e8 Result

      Seventy-five patients were recruited, meeting the required sample size (40 benign, 35 malignant). Factors entered into the model were the contribution of the affected hemithorax to ribcage tidal volumes, synchrony between abdominal and ribcage movements and variability of inspiratory to expiratory flow. The model was not significant (X2 4.234, p=0.237, Nagelkerke R2 0.073) and correctly classified 57.3% of cases. AUC was 0.581 (p=0.230, 95% confidence interval 0.450 to 0.712), this is not sufficient to be a clinically useful test. The contribution of the affected hemithorax to ribcage motion showed a trend for association with survival in patients who had biopsy proven mesothelioma (mean survival 334 days for <45% contribution, 95% confidence interval 218-450, vs 993 days for >45% contribution, 95% confidence interval 633-1353, p=0.065).

      8eea62084ca7e541d918e823422bd82e Conclusion

      roc curve for world lung.tif
      Performing SLP prior to biopsy does not aid in the differentiation of benign versus malignant pleural disease. Further research into the usefulness of assessing chest wall motion in prognostication and staging of mesothelioma is required.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P3.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 982)

    • 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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      P3.16-38 - Systematic Review and Meta-Analysis of Methods to Predict Postoperative Lung Function Following Lung Cancer Resection (ID 12894)

      12:00 - 13:30  |  Author(s): Rana Mehdi

      • Abstract
      • Slides

      Background

      Prediction of postoperative lung function is a critical part of assessment of fitness for lung cancer resection. Multiple techniques of prediction have been reported but formal assessment of the comparative accuracy of these methods has not been performed.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      A systematic review and meta-analysis using the generic inverse variance method was performed according to a prospectively registered strategy (PROSPERO ID:[CRD42017058955]). Extraction of accuracy measures to predict postoperative FEV1, FVC and TLCO was planned; assessment of bias was performed using a preliminary version of the PROBAST tool.

      4c3880bb027f159e801041b1021e88e8 Result

      Searches retrieved 3817 studies, of these 17 met inclusion criteria and passed risk of bias assessment for inclusion in meta-analysis. Most studies measured FEV1. Only 1 study which passed risk of bias assessment reported absolute TLCO values. All techniques had a Standard Error range of more than the minimum clinically important difference in FEV1 of 100ml, CT measures of lobar volume and lung tissue density had the lowest range at 207ml.

      world lung table sr.tif

      8eea62084ca7e541d918e823422bd82e Conclusion

      Prediction based on the commonly used methods of segment or subsegment counting gives imprecise estimates of postoperative lung function and may lead to patients being turned down for curative resection. More precise methods using CT density and volume are preferable. There is inadequate evidence to justify any prediction technique for postoperative TLCO over another.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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