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Daisuke Nakajima
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P2.05 - Interventional Diagnostic/Pulmonology (ID 168)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Interventional Diagnostics/Pulmonology
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.05-08 - Diagnostic Yield of EBUS-TBNA in Evaluation of PD-L1 Expression for Advanced Non-Small Cell Lung Cancer (ID 1825)
10:15 - 18:15 | Author(s): Daisuke Nakajima
- Abstract
Background
Endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) plays a major role in mediastinal staging for advanced non-small cell lung cancer, but the amount of obtained tissue is limited compared to surgical biopsy. The purpose of this study was to assess the diagnostic yield of EBUS-TBNA in evaluating PD-L1 expression in positive mediastinal lymph nodes.
Method
A retrospective chart review was performed on our prospectively maintained database to identify patients who underwent EBUS-TBNA to evaluate PD-L1 expression in mediastinal lymph nodes associated with advanced non-small cell lung cancer between April 2017 and March 2019. Relevant factors were extracted and compared between those whose PD-L1 expression was able to be evaluated and those whose PD-L1 expression was not.
Result
Thirty-six patients were identified. The PD-L1 expression was able to be evaluated in 30 (83%) of 36 patients. There were tendencies for a greater diameter (p=0.19) and higher standard uptake value (SUV) in positron emission tomography (p=0.22) of biopsied lymph nodes, and a greater number of biopsies (p=0.28) in those whose PD-L1 expression was be able to be evaluated. Among 30 patients with evaluable PD-1 expression, the degree was high expression (tumor proportion score (TPS) ≧ 50%) in 7 patients (23%), low expression (TPS 1-49%) in 10 patients (33%), and no expression (TPS < 1%) in 13 patients (44%).
Conclusion
Evaluation of PD-L1 expression was feasible in more than 80% patients undergoing EBUS-TBNA for positive mediastinal lymph nodes associated with advanced non-small cell lung cancer. EBUS-TBNA appeared to play an important role in evaluating PD-L1 expression. A larger lymph node, and a lymph node with higher SUV, and a greater number of punctures appeared favorable in evaluation of PD-L1 expression.
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P2.17 - Treatment of Early Stage/Localized Disease (ID 189)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment of Early Stage/Localized Disease
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.17-26 - Indocyanine Green Virtual Assisted Lung Mapping (ICG-VAL-MAP): Anyone Can Perform a Successful Preoperative Marking for a Small Lung Nodule (Now Available) (ID 2320)
10:15 - 18:15 | Author(s): Daisuke Nakajima
- Abstract
Background
As a preoperative marking of small pulmonary nodules, we developed Virtual Assisted Lung Mapping (VAL-MAP), which is consisted of preoperative simulation using three-dimensional CT images and transbronchial dye marking using indigocarmine (IC). Between 2012 and 2016, we performed VAL-MAP in more than 200 cases in a single institution; however, we sometimes came across a situation, in which an identification of marked IC was difficult at post-marking CT and/or during surgery. Herein, we have developed a new VAL-MAP (ICG-VAL-MAP) using indocyanine green (ICG) and contrast agent. The purpose of this study was to prospectively evaluate the visibility of newly-developed ICG-VAL-MAP in an identification of ICG at post-marking CT as well as during surgery.
Method
Between January in 2017 and February in 2019, we performed ICG-VAL-MAP, using ICG and contrast agent in addition to IC as a marker for preoperative nodule identification, in 88 patients at our institution. Preoperative marking was performed on the same day as surgery or 1 day before surgery. During surgery, fluorescence endoscope system was used for identification of marked ICG.
Result
Targeted lesions were 105 nodules with the diameter ranging from 2 to 38 mm (median 8 mm). The depth of the lesion from the pleural surface ranged from 0 to 49 mm (median 8 mm). Total marking numbers were 208 (IC: 99, ICG: 109). At post-marking CT, IC was easily identified in 78 markings (78%), difficult to be identified in 10 markings (10%), and unable to be identified in 11 markings (11%). On the other hand, ICG was easily identified in all markings at post-marking CT. During surgery, IC was easily identified in 74 markings (74%), slightly identified in 4 markings (4%), and unable to be identified in 21 markings (21%). On the other hand, ICG was easily identified in 108 markings (99%) during surgery. Only in 1 case, ICG marking was accidentally placed far from a pleural surface, but ICG was slightly identified in a collapsed lung during surgery. In summary, ICG was significantly easily identified than IC during surgery (P<0.0001) as well as at post-marking CT (P=0.0002). There were no significant perioperative complications related to ICG-VAL-MAP. All nodules were identified intraoperatively and an appropriate surgical resection was conducted in each patient. In details, 53 wedge resections, 48 segmentectomies and 2 lobectomies were performed. Furthermore, all nodules were diagnosed pathologically (74 primary lung cancer, 24 metastatic lung cancer, and 7 benign nodule).
Conclusion
We confirmed that ICG-VAL-MAP was a novel and promising technique with better visibility than conventional VAL-MAP for the complete resection of small pulmonary nodules.