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Su Kyung Hwang
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EP1.11 - Screening and Early Detection (ID 201)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Screening and Early Detection
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.11-16 - Comparison of Three Diagnostic Modalities for Lung Nodules (Now Available) (ID 1397)
08:00 - 18:00 | Presenting Author(s): Su Kyung Hwang
- Abstract
Background
Lung cancer screening and computed tomography (CT) have increased the detection of lung nodules. However, the diagnosis and selection of diagnostic modality are difficult for small nodules. The objective of this study was to determine the appropriate modality for lung nodule diagnosis.
Method
We reviewed 446 consecutive cases that underwent radial endobronchial ultrasound (EBUS), percutaneous needle aspiration (PCNA), or surgical resection for the diagnosis of lung nodules (≤3cm) from February 2017 to January 2019. The patients underwent contrast-enhanced chest CT in our hospital before each examination. We performed retrospective data collection and analysis.
Result
Radial EBUS was performed in 120 (27%) cases, of which 73 had a proper diagnosis; PCNA was performed in 151 (34%) cases, of which 131 had a proper diagnosis; surgical resection was performed in 175 (39%) cases, of which 172 had a proper diagnosis. We detected malignancy, benign nodules, and atypical cells in 290 (65%), 139 (31%), and 17 (4%) cases, respectively. The mean sizes measured on CT were 20, 19.7, and 12.1 mm in PCNA, radial EBUS, and surgical resection, respectively (p<0.001). The lung lobe with nodules (p=0.762) was not statistically different among the modalities. Radial EBUS was preferred for centrally located nodules (55/120; 45.8%; p<0.001). Surgical resection showed many portions of ground-glass opacity nodules (p<0.001). PCNA was attempted in peripherally located or solid lung nodules (p <0.001). The failure of diagnosis with PCNA, radial EBUS, and surgical resection occurred in 20 (13.2%), 47 (39.2%), and 3 (1.7%) cases, respectively (p <0.001).
Conclusion
Surgical resection is preferable for small lung nodules and ground-glass opacity nodules; PCNA is preferable for peripherally located and solid nodules; radial EBUS is preferable for centrally located nodules. It is important to select the diagnostic modality based on the characteristics of each nodule.
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EP1.17 - Treatment of Early Stage/Localized Disease (ID 207)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Treatment of Early Stage/Localized Disease
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.17-01 - Surgical Resection of Synchronous Quadruple Primary Lung Tumors Present as Three-Different Cancers and One Benign Mass (Now Available) (ID 673)
08:00 - 18:00 | Author(s): Su Kyung Hwang
- Abstract
Background
Synchronous triple lung cancer is uncommon and little is known, making it difficult to establish proper guidelines or treatment strategies. In this report, we describe a 70-year-old male with three synchronous independent and histologically different primary cancers and one benign hamartoma.
Method
Chest CT showed a 30 mm-sized lobulated lung mass in posterior basal segment of the left lower lobe (tumor 1) (Figure 1A). In addition, there were another 26 mm-sized well defined solid nodule in the right lower lobe (tumor 2) (Figure 1A). Two sub-centimeter nodules were also presented in superior segment of the right lower lobe (tumor 3) (Figure 1B) and the lingular segment of the left upper lobe (tumor 4) (Figure 1B). A transthoracic percutaneous needle aspiration biopsy performed on the 30 mm-sized nodule in the left lower lobe revealed it as squamous cell carcinoma.
Result
During the right side surgery, intraoperative frozen biopsy of tumor 2 and tumor 4 were reported as chondroid hamartoma and adenocarcinoma, respectively. As we already knew that the left side tumor was squamous cell carcinoma, we decided to continue left side surgery with mediastinal lymph node dissection. The final results of the pathological examination of tumor 1 showed squamous cell carcinoma of pT2bN1M0 (Figure 2A), stage IIB. Tumor 2 was diagnosed as chondroid hamartoma (Figure 2B). Small nodules located in the right lower lobe (tumor 3) and left upper lobe (tumor 4) were 6 mm-sized adenocarcinoma with visceral pleural invasion (pT2aNx) (Figure 2C) and 7 mm-sized adenoid cystic carcinoma (pT1aN0) (Figure 2D), respectively. There was no recurrence during the 3-year follow-up period.
Conclusion
Appropriate preoperative staging work up including HRCT and percutaneous needle aspiration biopsy can allow timely detection of synchronous multiple lung cancer, offer proper surgical strategy, and give the possibility of implementing potentially curative treatment for patients conventionally misdiagnosed or considered as metastasized.
