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Carlos Martinez-Barenys
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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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EP1.17-25 - Radio-Guided Localization of Small Lung Nodules (Now Available) (ID 58)
08:00 - 18:00 | Author(s): Carlos Martinez-Barenys
- Abstract
Background
The widespread use of computed tomography and the obligation of early diagnosis and treatment of small lung nodules have increased in recent years. There are few localization techniques, ROLL seems one of the safest and most effective. The purpose of this study is to report our experience.
Method
We have retrospectively reviewed all patients with undetermined lung nodule that underwent radio-guided localization.
The aim of the study was to evaluate the efficacy of the ROLL for the diagnosis and treatment of small lung nodules.
The morning of the surgery, Tc99 macroaggregated albumin was injected guided by computer tomography. Afterwards a SPECT-CT was performed to check the correct localization of the tracer and the patient was brought into the operating room. During the surgery a gamma probe connected to a gamma ray was introduced and the lung surface scanned. After detecting the higher value area, a lung resection was performed and the lung is rescanned to check the residual activity (less than 10%).
Result
Between November 2011 and February 2019, 30 patients (22 male and 8 female) underwent radiotracer injection followed by lung resection surgery in our institute. Mean age was 66,3 years (range 52 to 76 years). The main complication was pneumothorax (9 patients, 30%), but no patient required chest drainage. There was one non-complicated aortic puncture. There were no other complications.
The mean nodule size was 9,07mm +/- 4,35mm and the mean visceral pleural distance was 19,6mm +/-16,27mm. By radiology characteristics, 16 were ground glass opacities, 10 solid nodules and 4 partially solid nodules.
The lesions were well detected in 100% cases. They were resected by wedge resection in all the cases. The final pathologic diagnosis confirmed 12 lung adenocarcinoma (6 lepidic growth adenocarcinoma, 3 adenocarcinoma in situ, 2 solid adenocarcinomas, 1 minimally invasive adenocarcinoma), 12 lung metastasis, 2 atypical adenomatous hyperplasia, 2 inflammatory nodules, 1 squamous carcinoma and 1 hamartoma. Clean margins were obtained in 28 patients (93,3%). There were not intraoperative and postoperative complications secondary to the procedure.
Conclusion
The radio-guided localization is a simple, easy and safe procedure for the diagnosis and treatment of small lung nodules. There were not problems of radiotracer lung diffusion and misplacement.
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P2.13 - Staging (ID 315)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Staging
- Presentations: 2
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.13-01 - PET-CT Underestimates Unexpected pN2 in Lung Adenocarcinoma (Now Available) (ID 542)
10:15 - 18:15 | Author(s): Carlos Martinez-Barenys
- Abstract
Background
Accuracy in lung staging is essential for the management of lung cancer. Positron emission tomography (PET-CT) allows us to identify occult disease and avoid unnecessary surgeries in patients with extended disease. In recent years, the histological distribution has varied in non-small cell lung carcinomas. Historically, squamous carcinoma had been more frequent, but in recent years adenocarcinoma has been progressively increasing its incidence.
Method
We have retrospectively reviewed all patients that underwent surgery after cN0-N1 staging. Staging studying consisted in chest computed tomography, PET-CT and fiberbronchoscopy. In case of increased mediastinal PET-CT uptake, hiliar lesion, N1 involvement or tumour greater than 3 cm an endobronchial ultrasound (EBUS) and / or mediastinoscopy was performed.
Our aim was to study if this histological change has increased our occult pN2 in cN0-N1 patients
Result
Between January 2010 and March 2016, 484 patients were consecutively operated. 112 patients (92 men and 20 women) had hilar or mediastinal homolateral involvement. The average age was 63.62 years +/- 8.99. The initial nodal involvement was cN0 73.2% (82 patients), cN1 21.4% (24p) and ycN0 after neoadjuvant therapy 5.4% (6p). The following data were analysed: age of the patient, sex, histology of the lesion, staging, location, type of resection performed, laterality and nodal involvement. Subsequently, the statistical analysis was performed with SPSS 25.
The most frequent histology was adenocarcinoma in 256 patients (52.89%), squamous carcinoma in 198 (40.9%), other 30 (6.1%). 25.78% adenocarcinoma (66p) and 23.23% squamous carcinoma (46p) presented nodal involvement. By zones, N1 and N2 involvement was 11.71% (30p) and 14.06% (36p) in adenocarcinoma group. 16.16% (32p) and 7.07% (14p) in squamous group (p <0.05). The odds ratio for occult pN2 was 1,988 in adenocarcinoma (p<0.05).
Conclusion
PET-CT underestimates the presence of unexpected pN2 in adenocarcinoma lung cancer. Further mediastinal investigations may be necessary in these patients prior to surgical resection
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P2.13-05 - Endobronchial Ultrasound for Mediastinal Restaging in Non-Small Cell Lung Cancer (Now Available) (ID 858)
10:15 - 18:15 | Author(s): Carlos Martinez-Barenys
- Abstract
Background
The adequate mediastinal restaging following neo-adjuvant therapy (NAT) in operable patients with non-small cell lung cancer (NSCLC) and N2 spread is crucial. Mediastinoscopy is the gold standard for mediastinal restanging, but endosonographic procedures are less invasive and can be an alternative. AIM: Evaluate the role of endobronchial ultrasound-guided transbronchial needle aspirate EBUS-TBNA in mediastinal the restaging of NSCLC.
Method
Prospective study with 32 patients with CPNCP N2 spread confirmed by TNBA-EBUS, collected from June 2010 to October 2018. These patients were subjected to neoadjuvant treatment (chemotherapy or radio-chemotherapy), subsequently were performed mediastinum restage with TNBA-EBUS. The negative cases were subjected to mediastinoscopy or thoracotomy.
Result
Of the 32 cases, the basal characteristics are detailed in table 1. Were analysed 229 lymph nodes, 42 of these were malignant (18%). TNBA-EBUS after neoadjuvant treatment showed persistence of N2 spread in 19 cases (52%). In negative cases (n=13; 41%) were performed mediastinoscopy (n=11) or surgery (n=1). After these procedures were confirmed mediastinal disease in 3 cases, 9 lymph nodes of 43 removed. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 86.4%, 100%, 100%, 72.7% and 90% respectively. There was recurrence of the disease in 15 cases (47%). We found a significant difference between recurrence and the type of neoadjuvant treatment (chemotherapy vs. radio-chemotherapy), p=0.047.
Table 1.
Conclusion
TBNA-EBUS is an appropriate semi-invasive tool in mediastinal restage after neoadjuvant treatment, with high diagnostic accuracy. Nevertheless, in negative cases is still necessary support with invasive procedures.
