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Sabita Jiwnani
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EP1.12 - Small Cell Lung Cancer/NET (ID 202)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Small Cell Lung Cancer/NET
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.12-05 - Is There a Role for Mediastinal Lymph Node Dissection in Pulmonary Carcinoids? (Now Available) (ID 2608)
08:00 - 18:00 | Author(s): Sabita Jiwnani
- Abstract
Background
Pulmonary carcinoids are slow growing tumours with surgery being the mainstay of treatment. Histology(typical/atypical) and nodal status are known prognostic markers. In light of the results of the ACOSOG Z0030 trial, the role of mediastinal lymphnode dissection in surgery for NSCLC is being questioned. This question becomes more pertinent in pulmonary carcinoids, where nodal positivity is known to adversely impact survival and surgery is the only curative treatment option.
Method
We performed a retrospective analysis of a prospectively maintained database of surgery in pulmonary carcinoids. Data regarding histology, type of surgery, imaging, nodal status, margin status and follow up were captured from the database and where missing, from the electronic medical records. Statistical analysis was performed using SPSS version 20 for Mac.
Result
141 patients with pulmonary carcinoid tumours treated with curative intent in a single center from August 2004 to February 2017 were included. 108 (76.6%) were typical carcinoids and 29 (20.6%) were atypical carcinoids. 4 patients were not classified. 120 (86.42%) patients underwent mediastinal nodal sampling or systematic clearance. The median survival in patients undergoing lymphnode dissection was 66 months, where as it was 53.5 months in those who did not( p = 0.43). Twenty (16.66%) patients were node positive. Node positivity rate in typical carcinoids was 11.11%, while that in atypical carcinoids was 27.58% After a median follow up of 57 months, 115 (81.6%) patients are alive and disease free, 10 (7.1%) are alive with disease, 6 (4.3%) have died due to disease, 6 (4.3%) have died due to other causes. Estimated 5 yr survival in patients with typical carcinoids is 96.9% while that of patients with atypical histology is 67.8%. (p<0.001) Patients with positive nodes had an estimated 5 yr survival of 80.5% while that in node negative patients was 95.37%. (p=0.12).
Conclusion
In our series, the node positivity rate was higher than reported in literature and this could be seen in both patients with typical and atypical histology. Nodal positivity also showed a trend towards decreased survival showing that it is an important prognostic factor. Lymphnode dissection showed a trend towards improved survival, though not statistically significant. The lack of statistical significance could be attributed to the fewer number of cases in the study and the lower number of events. In view of the relatively low morbidity of the procedure and the lack of any other curative treatment option we suggest that systematic lymph node dissection be performed for all cases of pulmonary carcinoids. A randomized study to answer this question appears unlikely.
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MA16 - Prioritizing Use of Technology to Improve Survival of Lung Cancer Subgroups and Outcomes with Chemotherapy and Surgery (ID 142)
- Event: WCLC 2019
- Type: Mini Oral Session
- Track: Treatment in the Real World - Support, Survivorship, Systems Research
- Presentations: 1
- Now Available
- Moderators:Jair Bar, Navneet Singh
- Coordinates: 9/09/2019, 15:45 - 17:15, Interlaken (1988)
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MA16.08 - Discussant - MA16.05, MA16.06, MA16.07 (Now Available) (ID 3784)
15:45 - 17:15 | Presenting Author(s): Sabita Jiwnani
- Abstract
- Presentation
Abstract not provided
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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P2.13 - Staging (ID 315)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Staging
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.13-03 - Is It Time to Replace Cervical Mediastinoscopy with EBUS-FNAC in Invasive Mediastinal Staging for NSCLC? (ID 2628)
10:15 - 18:15 | Author(s): Sabita Jiwnani
- Abstract
Background
Background: Cervical mediastinoscopy is considered the gold standard for mediastinal staging in NSCLC. However, the morbidity of this procedure is not inconsiderable and EBUS+/-EUS with guided FNAC is rapidly evolving as a replacement for mediastinoscopy.
Method
Aim: To evaluate EBUS-FNAC, in invasive mediastinal staging and assess the incremental value of mediastinoscopy.
Methods: Retrospective analysis of a prospectively maintained database of patients who underwent EBUS followed by mediastinoscopy and/or surgery within a month for potentially resectable NSCLC from February 2017 to March 2019. Lymph nodes in stations 2 and 4 bilaterally and 7 were sampled, if size 5mm or more/met radiological criteria on ultrasound. Patients with negative EBUS underwent mediastinoscopy and surgery depending on the results. Data regarding PET CECT features, sampling, cytology and final histopathology was analysed.
Result
During the study period, 126 patients underwent EBUS for staging. Thirty-eight patients had positive mediastinal nodes, 34 with N2 and 4 with N3 disease. Eighty-eight patients were staged as N0 on EBUS, of which 15 received definitive chemoradiotherapy and 8 patients had progression of disease or were lost to follow up before definitive treatment. Sixtyfive EBUS negative patients underwent either mediastinoscopy followed by lung resection(56) or upfront lung resection with systematic mediastinal lymph node dissection(9). Nine of these patients (65) had N2 disease, 5 detected on mediastinoscopy and 4 detected on surgery (three positive in stations not accessible by mediastinoscopy or EBUS and one in a patient who could not undergo mediastinoscopy). The 5 additional N2 cases detected by mediastinoscopy had sub centimetre lymph nodes with SUV < 3, but had undergone adequate sampling(median-3 passes) on EBUS.
Conclusion
Presence of metastatic disease in sub centimetre mediastinal lymph nodes with low SUV cannot be excluded by imaging and this may be critical in this era of multimodality management. The sensitivity of EBUS although excellent is further augmented by mediastinoscopy and it remains an integral part of mediastinal staging.
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SH02 - Highlight of the Previous Day (ID 99)
- Event: WCLC 2019
- Type: Highlight of the Previous Day Session
- Track:
- Presentations: 1
- Now Available
- Moderators:Grace Yang, Debora Gil
- Coordinates: 9/10/2019, 11:30 - 13:00, Melbourne (1991)
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SH02.06 - Diagnosis/Staging (Now Available) (ID 3856)
11:30 - 13:00 | Presenting Author(s): Sabita Jiwnani
- Abstract
- Presentation
Abstract not provided
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
