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Richard Booton
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EP1.05 - Interventional Diagnostics/Pulmonology (ID 195)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Interventional Diagnostics/Pulmonology
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.05-08 - Obtaining Diagnostic Lung Biopsies in Suspected Lung Cancer Patients (Now Available) (ID 2221)
08:00 - 18:00 | Author(s): Richard Booton
- Abstract
Background
Lung cancer screening programs will inevitably increase demand for lung biopsies, therefore best practice and standardised investigation pathways need to be well established. This study was designed to determine current practice in obtaining diagnostic lung biopsies in patients with suspected lung cancer.
Method
A retrospective study of CT-guided lung biopsies and frozen section biopsy procedures performed in 10 hospital trusts over 3 years. All pathology results were reviewed for patients with suspected lung cancer. The number of procedures performed, and the proportion of cancerous, benign and indeterminate findings were ascertained and compared for the two biopsy techniques. Relevant imaging was reviewed (by an experienced interventional thoracic radiologist) to determine whether patients met the criteria for a percutaneous CT-guided biopsy.
Result
607 frozen sections and 204 CT-guided biopsies were performed over three years in 10 hospital trusts for suspected lung cancer. Pathology results demonstrated that 23% of frozen sections were benign, 2% were indeterminate and 75% were cancerous. In comparison, 16% of CT-guided lung biopsies were benign, 30% indeterminate, and 54% cancerous.
Trends showed a gradual increase in the number of CT guided biopsies over 3 years, and a decrease in the number of frozen sections performed. There was a reduction in indeterminate CT-guided biopsy results and in benign frozen section results over the three-year period.
Most patients met the criteria for percutaneous CT-guided biopsy, based on size and location of the lesion and background lung function, yet frozen section biopsy frequently remained the first line approach.
Conclusion
Advancements in imaging and biopsy techniques promotes percutaneous CT-guided biopsy - the more favourable, less-invasive approach for obtaining lung tissue. However, many patients are still undergoing frozen section biopsies as the first-line option. A review of individual trust pathways is recommended to ensure standardisation of practice and that patients are offered the most appropriate investigation.
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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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P2.13-07 - CT Staging for Suspected Lung Cancer; Should We Routinely Image the Pelvis? (ID 1693)
10:15 - 18:15 | Author(s): Richard Booton
- Abstract
Background
Hospital trust imaging protocols for CT staging of suspected lung cancer vary with regard to inclusion of the pelvis. Imaging the pelvis allows for potential detection of pelvic metastases and appropriate subsequent management, but exposes the patient to a higher radiation dose. This study was designed to determine whether current practice could be improved and standardised.
Method
Retrospective study across 11 hospital trusts in the United Kingdom. All patients who had a PET-CT scan in 2014 for a new diagnosis of lung cancer were identified from hospital databases. PET-CT reports were reviewed and categorised by the lung cancer stage given in the report. Stage IV disease was further subcategorised into stage IV with pelvic metastases or stage IV without pelvic metastases.The initial staging CT was reviewed in all stage IV patients with pelvic metastases on PET-CT. The CT protocol was documented in addition to whether or not the pelvic metastases were identified.
Result
Pelvic bony metastases were identified in 4% of PET scans (66 patients). 11 of these 66 patients initially had a contrast-enhanced CT chest, abdomen and pelvis staging scan; 3/11 scans reported pelvic metastases. The remaining 55 patients did not have pelvic imaging prior to PET. Overall radiation exposure and costs were calculated; routine imaging of the pelvis during staging CT could result in an 18% increase in radiation exposure to the population and a 2% reduction in overall cost if subsequent PET imaging decreased by 4%.
Conclusion
Trust imaging protocols for CT staging of suspected lung cancer vary with regard to inclusion of the pelvis. Pelvic metastases from primary lung cancer are an uncommon finding on PET-CT scans (4%). CT chest and abdomen scans are sufficient for staging lung cancer given the low incidence of pelvic metastases and significant radiation exposure associated with pelvic imaging.
