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John English
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MA10 - Emerging Technologies for Lung Cancer Detection (ID 129)
- Event: WCLC 2019
- Type: Mini Oral Session
- Track: Screening and Early Detection
- Presentations: 2
- Now Available
- Moderators:Fabrizio Bianchi, Marcelo Sanchez
- Coordinates: 9/08/2019, 15:15 - 16:45, Dublin (1997)
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MA10.01 - Invasive Adenocarcinoma in Screen Detected Pure Ground-Glass Nodules (GGN) (Now Available) (ID 2736)
15:15 - 16:45 | Author(s): John English
- Abstract
- Presentation
Background
A major criticism of lung cancer screening initiatives is their propensity to instigate enhanced surveillance and over-treatment of otherwise indolent disease, including adenocarcinoma-in-situ (AIS). These nodules present radiographically as GGN. There are wide variations in the recommendations for surveillance (repeat imaging), diagnosis (biopsy) and therapeutic intervention (resection) for these lesions. To further our understanding of the optimal management of screen detected GGN, we used data from two screening studies in Canada with up to 17 years of follow-up to determine the proportion of persistent GGN that are invasive adenocarcinomas.
Method
Two lung cancer screening studies data sets were reviewed: the BC Lung Health Study (BCLHS) with 1365 participants and the Pan-Canadian Early Detection of Lung Cancer Study (PanCan) with 2537 participants. BCLHS enrolled ever smokers 45-74 years of age with >30-year smoking history. The median follow-up in this cohort was 12 years (0.1-17.6) The PanCan study screened participants age 50-75 years with a PLCOm2008 6-year lung cancer risk > 2%. The median follow-up was 5.5 years (3.2-6.1). The nodules were followed until they resolved, demonstrated stability for >2 yrs or were surgically resected. All pure GGO resected were re-reviewed and classified by two pulmonary pathologists according to the revised 2015 World Health Organization classification of lung tumours. Cancers were staged using the 8th edition of the AJCC/UICC cancer staging manual.
Result
A total of 18,589 nodules in 3902 participants were reviewed. 2392 (13% of all nodules) were classified as pure GGN. 1073 of the 2392 were > 5mm at the baseline scan. Of these 1073 GGN, 156 (15%) resolved, 879 (82%) remained pure GGN, 38 (3.5%) became part-solid or solid. 32(3%) of the GGN from 29 patients that demonstrated growth were resected. The median size prior to resection was 16 mm (range 7 to 33 mm). The histopathology distribution included: 19 invasive adenocarcinomas, 7 minimally invasive adenocarcinomas, 6 adenocarcinoma-in-situ. The TNM stage distribution and average size of the GGN on the CT prior to resection are listed in Table 1. Sixty-one percent of the invasive cancers (Stage IA1 to IIIA) were less than 20 mm. Eleven percent of the invasive adenocarcinomas had lymph node metastasis.
Conclusion
A high proportion of pure GGN that demonstrate growth are invasive cancers. The majority were < 20mm in size when they were resected. This has significant implication in the development of recommendations to manage screen detected GGN.
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MA10.09 - Evaluation of the Clinical Utility of the PanCan, EU-NELSON and Lung-RADS Protocols for Management of Screen Detected Lung Nodules at Baseline (Now Available) (ID 2137)
15:15 - 16:45 | Author(s): John English
- Abstract
- Presentation
Background
Several protocols are available to guide management of lung nodules identified by the first (baseline) low-dose screening CT. It is important to objectively assess their clinical utility, health care resource utilization and potential harms. We aim to compare the PanCan (NEJM 2013;369:908 & J Thorac Oncol 2018; 13(10): S362-S363), EU-NELSON (Lancet Oncol. 2017 Dec;18(12):e754-e766 & Lung Cancer 2006;54:177-184) and Lung-RADS(https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/Lung-Rads) lung nodule management protocols on our data set from two sites of the International Lung Screen Trial (ILST), in Vancouver, Canada and Perth, Western Australia.
Method
Ever smokers age 55 to 80 years were enrolled into ILST if they had a ≥30 pack-years smoking history and smoked within 15 years or if their PLCO m2012 6 year lung cancer risk was ≥1.51%. The participants were managed via the PanCan lung nodule risk based protocol. The NELSON and Lung-RADS nodule protocols were applied to the ILST data set. The potential difference in the proportion of the participants having an early recall CT scan (< 1 year) or referral to a clinical diagnostic pathway was compared between the PanCan, NELSON, Lung-RADS protocols. The participants were divided into 3 groups: Group 1 (next scheduled annual/biennial CT) included PanCan CAT 1, 2, NELSON NODCAT I, II, Lung-RADS CAT 1, 2. Group 2 (early recall CT <1 year) included PanCan CAT 3, NELSON NODCAT III, Lung-RADS CAT 3, 4A and Group 3 (Diagnostic Pathway) included PanCan CAT 4, 5, NELSON NODCAT IV (solid nodule), Lung-RADS CAT 4B, 4X. The number of participants and the lung cancer rate in each group was compared between the three protocols.
Result
A total of 1386 participants with a median follow-up of 10 months (ranging from 4-31 mos) were evaluated. The results are shown in Table 1.
PanCan selected the fewest individuals to early recall (Group 2 & 3) versus NELSON p=0.004 and detected the same number of lung cancers as did the NELSON and more than by Lung-RADS.
In addition, 81% of the PanCan group 1 participants were triaged to biennial repeat screening instead of annual screening in the NELSON and Lung-RADS protocols, which has substantial resource utilization and radiation exposure implications.
Conclusion
The personalized risk-based PanCan Protocol may decrease resource utilization and potentially minimize risk of screening for participants.
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