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Jin Mo Goo
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MS06 - An Interdisciplinary Approach to Optimal Nodal Staging (ID 69)
- Event: WCLC 2019
- Type: Mini Symposium
- Track: Staging
- Presentations: 1
- Now Available
- Moderators:Roser Saumench Perramon, Souheil Boubia
- Coordinates: 9/09/2019, 11:00 - 12:30, Toronto (1985)
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MS06.01 - Radiologic Staging (Now Available) (ID 3467)
11:00 - 12:30 | Presenting Author(s): Jin Mo Goo
- Abstract
- Presentation
Abstract
Current definitions of borders for lymph node stations based on a few anatomic landmarks have limitations to explain the three-dimensional location of lymph nodes. Variability in the classification of lymph node stations (especially N1 vs N2 and N2 vs N3 categories) inevitably results in different management and also has an impact on database for the future revision of staging. Several articles have dealt with the ambiguity of the IASLC map and proposed recommendations. The Japan Lung Cancer Society and the Japanese Society for Radiation Oncology map provided more detailed description about the borders of lymph node stations (1).
N2 vs N3
1. Station 1 and 2
- Proposal: Changing the lower border of #1 station (upper border of #2 station) to the thoracic inlet: upper border of the 1st ribs (anterior border of the 1st ribs on axial CT) (2) and manubrium
2. Station 3a
- Potential problem: Absence of sideness
- Proposal: Split 3a to 3aR and 3aL with a left lateral border of the SVC (3) OR No change (like subcarinal lymph node)
3. Station 3p
Current border
- Potential problem: Absence of sideness
- Proposal: Right-sided lymph node OR No change (like subcarinal lymph node)
4. Precarianl area (below the lower border of the azygos vein in the right side and upper rim of the left main pulmonary artery in the left side)
- Current border: Lymph nodes located in the precarinal area is currently #10, hilar lymph nodes, but there is no description for the border between the right and left.
- Proposal: Midline of the trachea
N1 vs N2
In the current IASLC lymph node map, the pleural reflection no longer serves as the border between nodal stations. However, still many physicians regard N2 lymph nodes as mediastinal lymph nodes, and a survey also support this trend (3). Therefore, if the IASLC abandons the notion that N2 lymph nodes are mediastinal lymph nodes, the current map needs only a minor modification. Instead, a clear announcement should be provided to avoid confusion from other researchers (2). If the IASLC regards N2 lymph nodes as mediastinal lymph nodes, major modifications are required.
5. Station 4 and 10
- Problematic area: Anterior aspect of the lower trachea and carina below the lower border of #4 lymph nodes are located in the mediastinum.
6. Station 5 and 10
- Problem: Pulmonary arteries are curved structures craniocaudally, and different interpretation of this border results in differeces among altases. The intersection of the left superior pumonary vein branch and left main pulmonary artery may serve as a clear border. If # 10 lymph nodes are classified as non-mediastinal lymph nodes, the border definition should also be modified.
References
1. Itazawa T, Tamaki Y, Komiyama T, et al. The Japan Lung Cancer Society-Japanese Society for Radiation Oncology consensus-based computed tomographic atlas for defining regional lymph node stations in radiotherapy for lung cancer. J Radiat Res 2017; 58:86-105.
2. El-Sherief AH, Lau CT, Wu CC, Drake RL, Abbott GF, Rice TW. International association for the study of lung cancer (IASLC) lymph node map: radiologic review with CT illustration. Radiographics 2014; 34:1680-1691.
3. El-Sherief AH, Lau CT, Obuchowski NA, Mehta AC, Rice TW, Blackstone EH. Cross-Disciplinary Analysis of Lymph Node Classification in Lung Cancer on CT Scanning. Chest 2017; 151:776-785.
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P1.11 - Screening and Early Detection (ID 177)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.11-18 - The Results of Mandatory Smoking Cessation Intervention in a Population-Based Lung Cancer Screening Trial (ID 1489)
09:45 - 18:00 | Author(s): Jin Mo Goo
- Abstract
Background
A large strand of research supports the idea of implementing a population-based lung cancer screening program using low-dose computer tomography to reduce lung cancer mortality. It has been recognized that one of the key factors contributing a successful lung screening program is its combination with smoking cessation intervention. This study provides results of smoking cessation intervention in a population-based lung cancer screening trial.
Method
Korean Lung Cancer Screening Project (K-LUCAS) is a single arm prospective nationwide lung cancer screening trial. In K-LUCAS, all currently smoking participants were provided with mandatory smoking cessation counselling. Smoking status of 5,144 currently smoking participants in K-LUCAS were surveyed by telephone 6 months after participation. There were some variations in the intervention; the department of which counselling is provided within; publically or privately operated smoking clinics; and whether or not counselling is provided simultaneously with screening results. The impact of such variations on smoking cessation is also reported.
Result
Participant’s motivation to quit smoking increased by 9.4% on average after participating in lung cancer screening. The smoking cessation rate was 24.7% and over 80% of quitters said that participation in lung cancer screening motivated them to quit smoking. The smoking cessation counselling was more effective when the smoking clinics are operated by national health insurance services than when operated privately by hospital and when counselling was provided simultaneously with screening results than when provided separately with screening results. The screening results itself also affected smoking cessation. The probability of quitting smoking for participants with positive screening results were significantly higher than participants with negative results.
Conclusion
Smoking cessation intervention combined with lung cancer screening program encourages smoking cessation for screening participants. Our results the highlights the importance of incorporating smoking cessation intervention in lung cancer screening program which would further enhance the effectiveness of lung cancer screening program.
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P2.11 - Screening and Early Detection (ID 178)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.11-16 - Variability in Reading Low-Dose Chest CT: Individual Readers vs. Central Review in a Nationwide Lung Cancer Screening Project (ID 2299)
10:15 - 18:15 | Author(s): Jin Mo Goo
- Abstract
Background
Variability in interpretation among readers or institutions is an important issue in the nationwide lung cancer screening. The potential of computer-aided detection and volumetry in reducing interobserver variability has rarely been investigated in the actual screening situation. This study aimed to evaluate the variability among experts in a nationwide lung cancer screening project.
Method
We evaluated 1647 consecutive baseline screening CT scans obtained during one month period of December 2017 from a nationwide lung cancer screening project in Korea (K-LUCAS) in which 14 institutions participated. One of 20 chest radiologists in each institution assessed CT scans using a thin-client system equipped with semi-automated nodule segmentation and computer-aided detection software based on Lung-RADS (institutional reading). One chest radiologist retrospectively reviewed all these CT scans while minimizing modification of segmentation results and rejection of tiny nodules (central review). Reading results between institutional reading and central review were compared. Per-case and per-nodule positive rates of central review using Lung-RADS and NELSON criteria were also compared.
Result
Per-case positive rate was significantly higher in central review (24.9% [410/1647; 11.1-32.7% across institutions] vs. 19.3% [319/1647; 5.6-30.0% across institutions]; P<.001), while per-nodule positive rate was significantly higher in institutional reading (10.2% [511/4497; 5.2-21.9%] vs. 19.9% [382/1920; 9.5-60.6%]; P<.001). The number of detected nodules was significantly larger in central review (3.04 vs. 1.17 nodule/case; P<.001), while the size of detected nodules was significantly smaller in central review (4.0 vs. 5.1 mm; P<.001). Variability in positive rates among institutions was significantly lower in central review (coefficient of variability, 21.9% vs. 40.2%; P=.044). Manual measurements after rejecting result of semi-automated segmentation occurred in 1.6% (80/5008) of nodules at central review and in 17.8% (342/1920) nodules at institutional reading. Positive rate with Lung-RADS was significantly higher compared with that of NELSON criteria (24.9% vs. 3.9%; P<.001), however, including indeterminate scan by NELSON criteria which requires additional scanning, positive rate was higher in NELSON criteria (24.9% vs. 33.4%; P<.001).
Conclusion
Even in a situation where computerized tools are adopted, considerable variability was observed in interpretation of lung cancer screening CT even among expert chest radiologists. The variability was mainly caused by discarding tiny nodules and modifying or rejecting segmentations results, and reduced by central review. The NELSON criteria did not reduce the number of additional scanning in nodule management compared with Lung-RADS. The value of reducing variability by applying stricter rules should be further investigated.
