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Claudia Franco



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    P2.09 - Pathology (ID 174)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Pathology
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.09-13 - Histological and Molecular Evaluation of Multiple Lung Carcinoma with Synchronic Presentation. Single-Center Study in Argentina (ID 2891)

      10:15 - 18:15  |  Author(s): Claudia Franco

      • Abstract

      Background

      The simultaneous presence of more than one tumor nodule in lung cancer patients requires histological assessment to classify them as synchronous or metastatic tumors, allowing correct staging. In certain cases, the distinction based only on histological features is challenging.

      Method

      An observational study was performed including 22 lung cancer cases with more than one nodule (17 of them with 2 nodules, 1 with 4 nodules and 2 with more than 4 small nodules). 21 cases corresponded to surgical specimens, and only 1 case corresponded to needle core biopsy. Only 2 nodules per patient were studied, selected according to histological or sizing criteria.

      Both nodules of each case was assessed histologically according to both WHO 2015 and comprehensive histologic assessment (CHA). Tumors were classified according to both histological criteria into 3 categories: Synchronous, metastatic or undefined.

      Gene mutations and fusions were assessed using Oncomine Focus Assay (Thermo Fisher) in Ion PGM platform (Thermo Fisher). Cases sharing at least 1 somatic mutation or fusion were considered metastatic tumors. Cases with different somatic mutations/fusions were considered synchronous tumors and those showing no mutations/fusions were classified as undetermined.

      Result

      Tumor nodule size in surgical specimens varied between 0,3 and 4 cm, whereas the biopsy case corresponded to an 8-cm mucinous adenocarcinoma.

      According to the WHO 2015 classification, 20 cases were adenocarcinomas (ADC), 1 was a squamous cell carcinoma and 1 was a large cell carcinoma.

      On WHO 2015 criteria-based histologic assessment, 10 cases were classified as metastatic (same features), 9 cases were considered synchronous (different features), whereas 3 cases remained undefined.

      Using CHA criteria, 7 cases were classified as metastatic (same features), 13 cases were considered synchronous (different features), whereas 2 cases remained undefined.

      Based on molecular testing, we found 6 (27,27%) related and 14 (63,64%) non-related tumors, whereas only 2 cases (9,09%) remained undetermined.

      Molecular testing was helpful classifying 2 CHA-undefined patients as synchronous, whereas 1 patient could not be re-classified due to the lack of mutations or fusions recognized by our panel.

      The combination of the WHO, CHA and molecular results helps solving discrepancies in undefined cases.

      Conclusion

      The combination of WHO 2015 and CHA criteria improves the accuracy of synchronous or metastatic tumors. The addition of molecular testing is useful to define discrepancies in challenging cases