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Heidy Diaz
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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): Heidy Diaz
- Abstract
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.
