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Federico Jauk



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    EP1.13 - Staging (ID 203)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Staging
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.13-01 - Multiple Lung Nodules: Histopathologic, Molecular and Clinic Approach Outcomes (Now Available) (ID 2913)

      08:00 - 18:00  |  Author(s): Federico Jauk

      • Abstract
      • Slides

      Background

      Distinguishing multiple primary lung cancers from intrapulmonary metastases in patients with synchronous multifocal lung carcinomas can be challenging. Histologic and molecular features, in conjunction with clinical and radiological information, can all be tools to assist with staging of multiple nodules.

      Method

      Retrospective descriptive study. Patients diagnosed with multiple lung nodules and underwent surgery between 07/2011 - 2/2018 were included

      Pathologists trained in lung cancer performed the histological diagnosis of each of the nodules according to WHO 2015 classification and comprehensive histologic assessment analysis and, subsequently, a molecular analysis by Oncomine Focus Assay panel in Ion PGM platform was made. We also carried out clinical and demographic analyzes.

      Result

      A total of 22 patients were retrospectively studied Median Age: 67,5 years old (r 39-79). Non smokers: 6/22 (27,7%) patients. 13/22 (59%) pts men. 95,5% was staging with PET before surgery/mediastinoscopy, 6 of them reported mediastinal lymph node involvement by PET but only mediastinal involvement was evidenced in the biopsy in 1 case.

      6 cases showed 2 nodules in same lobe, 12 cases showed 2 or more nodules in same lung but in different lobe, 2 cases bilateral nodules, (2 of 4 required sequential surgery).

      21/22 mediastinoscopy before surgery, Segmentectomy, lobectomy or both were the most frequent surgeries.

      The lobe most frequently affected was the right upper lobe (alone or combined) followed by the left lower lobe.

      There were no cases of neoadjuvant treatment and 6 patients required adjuvant chemotherapy. The decision to perform adjuvant was evaluated in the tumor board. 4/22 relapses (sites of relapses: nodes, bones, lung). One of them had performed adjuvant treatment.

      Despite a high rate of sub-lobar surgeries, the incidence of local relapse was low (1 case lung and 3 mediastinal nodes).

      With a median follow-up of 19 months there was only one death and 4 relapses.

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

      Conclusion

      Decisions regarding post-surgery treatments were not defined by molecular biology. Both the TNM and the histological concordance between the nodules were the main determinants to make a therapeutic decision. Gene panels could help make decisions based on these finding.

      Being able to address and differentiate early stages vs. intrapulmonary metastatic disease can have a prognostic impact and help predict the outcome and guide the therapy.

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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): Federico Jauk

      • 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