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Helmut Prosch
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EP1.01 - Advanced NSCLC (ID 150)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Advanced NSCLC
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.01-31 - PET CT Radiogenomic Depiction in PDL1 Expression in Lung Cancer in Indian Population (Now Available) (ID 1230)
08:00 - 18:00 | Author(s): Helmut Prosch
- Abstract
Background
Non small cell lung cancer (NSCLC) represents an area of paramount importance wherein patients undergo testing for targetable genetic alterations. Association between the imaging and molecular phenotypes needs to be explored highlighting the growing importance of classifications based on radio genomic characterization. This study was conducted to evaluate the correlations between the radiologic and molecular phenotypes in patients with NSCLC.
Method
211 patients with lung cancers during the study period of one year from October 2017 till November 2018 in our institution and undergoing both radiologic (PET-CT) and molecular investigations [Programmed death ligand 1 (PDL1)] were included in the study. Both quantitative and qualitative CT findings were evaluated and correlated with the molecular findings. Quantitative data included SUV max obtained from PET component of CT and maximum diameter of lesion according to the RECIST criteria. Qualitative data recorded included location, pleural tail, pleural effusion, pericardial effusion, opacity, margins, calcifications, obstructive changes, pleural nodules, lung nodules, invasion, air bronchogram, emphysema, pulmonary fibrosis, mediastinal lymph nodes and distant metastasis. Statistical analysis was performed to evaluate the association of the qualitative features with the molecular expression. Receiver operating characteristic curves (ROC) were drawn and the corresponding area under curve (AUC) was calculated. P-values <0.05 were considered significant.
Result
PDL1 expression was observed in 69 patients and 13/14 females and 29/34 non-smokers showed the expression (p-value <0.0001). A total of 1, 19, 22 and 27 patients had <1%, 1-10%, 10-50% and >50% PDL1 expression. SUV max was 11.7+3.7 in the group with PDL1 expression. Correlations were observed between PDL1 expression and location (p-value <0.0001), pleural tail (p-value <0.0001), pleural effusion (p-value <0.0001), obstructive changes (p-value 0.001), pleural nodule (p-value 0.001), lung nodules (p-value <0.0001), air bronchogram (p-value <0.0001), emphysema (p-value <0.0001), mediastinal nodes (p-value <0.0001) and distant metastasis (p-value <0.0001). PDL1 expression correlated with pulmonary fibrosis (p-value 0.001). In ROC curves, in case of PDL1 expression, the AUC was 0.728 on the basis of length.
Conclusion
The correlation between CT findings and molecular findings highlights the importance of newer radio genomic based characterization for patients with NSCLC for better diagnostic and prognostic approaches.
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P2.01 - Advanced NSCLC (ID 159)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Advanced NSCLC
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.01-77 - PET CT Radiogenomic Depiction with EGFR and ALK Molecular Alterations in Lung Cancer Among Indian Population (Now Available) (ID 660)
10:15 - 18:15 | Author(s): Helmut Prosch
- Abstract
Background
Non small cell lung cancer (NSCLC) represents an area of paramount importance wherein patients undergo testing for targetable genetic alterations. Association between the imaging and molecular phenotypes is vital highlighting the growing importance and unmet need of classifications based on radio genomic characterization. This study was conducted to evaluate the correlations between the radiologic and molecular phenotypes in patients with NSCLC.
Method
211 patients with lung cancers during the study period of one year from October 2017 till November 2018 in our institution and undergoing both radiologic (PET-CT) and molecular investigations [Epidermal Growth Factor Receptor (EGFR), Anaplastic lymphoma kinase (ALK)] were included in the study. Both quantitative and qualitative CT findings were evaluated and correlated with the molecular findings. Quantitative data included SUV max obtained from PET component of CT and maximum diameter of lesion according to the RECIST criteria. Qualitative data recorded included location, pleural tail, pleural effusion, pericardial effusion, opacity, margins, calcifications, obstructive changes, pleural nodules, lung nodules, invasion, air bronchogram, emphysema, pulmonary fibrosis, mediastinal lymph nodes and distant metastasis. Statistical analysis was performed to evaluate the association of the qualitative features with the molecular expression. Receiver operating characteristic curves (ROC) were drawn and the corresponding area under curve (AUC) was calculated. P-values <0.05 were considered significant.
Result
Overall, EGFR mutation positivity and ALK rearrangement was observed in 114 and 37 patients, respectively whereas 60 patients had neither of these. SUV max was comparable between the groups with EGFR mutation (11.3+3.9) and ALK rearrangement (12.3+4.0). Correlations were observed between EGFR mutation and ALK rearrangement and location (p-value <0.0001), pleural tail (p-value <0.0001), pleural effusion (p-value <0.0001), obstructive changes (p-value <0.025), pleural nodule (p-value <0.002), lung nodules (p-value <0.002), air bronchogram (p-value <0.002), emphysema (p-value <0.002), mediastinal nodes (p-value <0.002) and distant metastasis (p-value <0.002). EGFR mutation also correlated with invasion (p-value 0.022). In ROC curves, for EGFR mutation and ALK rearrangement prediction based on mediastinal lymph nodes, the AUC was 0.661 and 0.588, respectively.
Conclusion
The correlation between CT findings and molecular findings highlights the importance of newer radio genomic based characterization for patients with NSCLC for better diagnostic and prognostic approaches.
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WS04 - Staging Workshop Part 1: IASLC Database Challenges and Application (ID 105)
- Event: WCLC 2019
- Type: Workshop
- Track: Staging
- Presentations: 1
- Now Available
- Moderators:Paula Antonia Ugalde, Maria Teresa Tsukazan
- Coordinates: 9/09/2019, 14:00 - 15:30, San Francisco (2009)
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WS04.02 - Challenges in Imaging Evaluation to Enter Data in the IASLC Database (Now Available) (ID 3679)
14:00 - 15:30 | Presenting Author(s): Helmut Prosch
- Abstract
- Presentation
Abstract
Soon after the publication of the proposals for the 8thedition of the TNM staging system, the International Association for the Study of Lung Cancer (IASLC) opened a new database for data collection for the next iteration of the lung cancer staging system (1).
The database contains more than 450 fields, which address data on patient characteristics, baseline laboratory values, as well as the results of pulmonary function, imaging, and pathological tests. As the database collects the data about lung cancer newly diagnosed between January 1, 2011, and December 31, 2019, the data entered might be predominantly retrospectively collected in some centers.
From an imaging perspective, this might lead to a number of problems. First, at least some of the elements required by the database might not be mentioned in the radiological reports. This may necessitate a re-evaluation of the imaging studies by an experienced radiologist, which might not be possible in all centers. Furthermore, the levels of training of the radiologists and reporting across different countries may be variable and thus introduce some degree of imprecision into the quality of the data.
As an example, in T staging, particular attention has to be paid to thorough measurements to ensure that the largest diameter in the axial, coronal, or sagittal plane is measured (2). Caution should also be taken not to overdiagnose additional pulmonary nodules as metastases. In N staging, particular attention has to be paid to the lymph node atlas-mining, particularly the well-known pitfall in the correct assignment of lymph nodes at levels 4 and 10 (3-5).
Furthermore, the quality of imaging and the availability of more advanced/expensive imaging techniques may also vary from country to country. As an example, the availabilities of PET/CT and/or MRI are not homogenous all over the globe. However, if PET/CT is not performed routinely in operable patients, as many as 20% of unexpected distant metastases might be missed (6).
Future staging projects should specifically address these issues in order to further improve the the quality of data necessary to improve the next iteration of the staging system.
1. Giroux DJ, Van Schil P, Asamura H, Rami-Porta R, Chansky K, Crowley JJ, et al. The IASLC Lung Cancer Staging Project: A Renewed Call to Participation. J Thorac Oncol. 2018;13(6):801-9.
2. Travis WD, Asamura H, Bankier AA, Beasley MB, Detterbeck F, Flieder DB, et al. The IASLC Lung Cancer Staging Project: Proposals for Coding T Categories for Subsolid Nodules and Assessment of Tumor Size in Part-Solid Tumors in the Forthcoming Eighth Edition of the TNM Classification of Lung Cancer. J Thorac Oncol. 2016.
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(4):776-85.
4. 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(6):1680-91.
5. Aviram G, Revel MP. Misclassification of Lymph Nodes in Lung Cancer Staging: Can We Improve? Chest. 2017;151(4):733-4.
6. Fischer B, Lassen U, Mortensen J, Larsen S, Loft A, Bertelsen A, et al. Preoperative Staging of Lung Cancer with Combined PET-CT. N Engl J Med. 2009;361(1):32-9.
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