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Nobuyasu Kurihara



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    P2.09 - Pathology (Not CME Accredited Session) (ID 958)

    • 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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      P2.09-03 - Rapid-Immunocytochemistry for Evaluation of Surgical Margin in Sublobar Pulmonary Resection (ID 13130)

      16:45 - 18:00  |  Presenting Author(s): Nobuyasu Kurihara

      • Abstract
      • Slides

      Background

      Histological evaluation of surgical margin for pulmonary malignant tumor in sublobar resection is difficult in automatic suture instrument (stapler) used in thoracoscopic surgery. In order to solve this problem, we devised a novel surgical margin assessment method that combined with rapid-immunocytochemistry (R-ICC) of stapler lavage solution and examined its usefulness. We developed a device that enables rapid-IHC (R-IHC) analyses within 20 minutes. By applying this device to R-ICC, we can perform intraoperative R-ICC within 30 minutes. By using this method, it is a possibility that the surgical margin can be accurately evaluated more than papanicolaou staining alone.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      From September 2016 to December 2017, we examined 21 lesions of pulmonary malignant tumor in 21 patients who underwent sublobar resection at Akita University Hospital. There were 12 male and 9 female patients whose ages ranged from 45 to 83 years old. Six patients underwent segmentectomy and 15 of ones underwent wedge resection. Histological diagnosis of staple stump and cytological diagnosis of staple lavage fluid (papanicolaou staining) and R-ICC were performed. The cases were classified by pathological results, and each cases were followed up. We performed R-ICC using each antibodies against for cytokelatin (CK) 20, CK 7 and Thyroid transcription factor-1 (TTF-1) in adenocarcinoma, p-40 in squamous cell carcinoma, respectively.

      4c3880bb027f159e801041b1021e88e8 Result

      The histological diagnoses were 4 lung adenocarcinomas, 5 squamous cell carcinomas, 7 colorectal adenocarcinomas, 1 renal cell carcinoma, 1 hepatocellular carcinoma, 1 duodenal cancer, 1 endometrial cancer and 1 bile duct cancer. No histological diagnosis of staple stump observed malignant findings in all cases. On the other hand, in conventional cytological diagnoses there were 2 cases of class V, 1case of class IV and 1 case of class III. R-ICC were positive in all 4 cases of class III or higher. Among 4 cases, we performed additional resection in two cases of class V, but not in the other two cases because difficulty in further resection. In the case of class IV without additional resection, local recurrence was observed in 4 months after surgery.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Among 21 cases, local recurrence was observed in one patient with positive cytological diagnosis and positive R-ICC diagnosis. There is a possibility that staple lavage fluid cytology can more accurately evaluate the stump than the tissue crushed by the staple. If there are very few cancer cells in the lavage fluid, R-ICC may be useful for cancer cell detection.

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