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Chong Kin Liam
Author of
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MA05 - Lung Cancer Screening (ID 174)
- Event: WCLC 2020
- Type: Mini Oral
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 1/30/2021, 11:45 - 12:45, Scientific Program Auditorium
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MA05.01 - Chair (ID 4162)
11:45 - 12:45 | Presenting Author(s): Chong Kin Liam
- Abstract
Abstract not provided
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P68 - Tumor Biology and Systems Biology - Basic and Translational Science - Radiomics (ID 207)
- Event: WCLC 2020
- Type: Posters
- Track: Tumor Biology and Systems Biology - Basic and Translational Science
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P68.01 - Qualitative Computed Tomographic Features Predict Epidermal Growth Factor Receptor Mutations in Advanced Lung Adenocarcinoma (ID 1441)
00:00 - 00:00 | Presenting Author(s): Chong Kin Liam
- Abstract
Introduction
Current guidelines recommend reflex testing for EGFR mutations in patients with advanced lung adenocarcinoma. Although tissue biopsy is considered the “gold standard” for EGFR mutation testing, it may not always be feasible in a small group of patients. Hence, this study aims to determine the computed tomography (CT) features that may predict the presence of common sensitising EGFR mutation in newly diagnosed advanced lung adenocarcinoma patients.
Methods
182 diagnostic contrast enhanced CT-images of newly diagnosed advanced lung adenocarcinoma patients who attended University Malaya Medical Center from 2010 to 2014 were analysed. For EGFR mutation testing, tissue biopsy specimens of all patients were tested for exon 19 deletion and exon 21 L858R point mutation.
Results
Of the 182 patients, 158 patients with measurable primary tumour, were included in the analysis. 67 (42.4%) patients had common sensitising EGFR mutations, of which 43 (64.1%) were exon 19 deletion and 24 (35.9%) were exon 21 L858R point mutation.
CT features of these patients are stated in Table 1. Common sensitising EGFR mutations were significantly more common in primary tumours with round contour (p = 0.029), homogenous enhancement (p = 0.029) and presence of air-bronchogram (p = 0.029). On the other hand, presence of emphysema (p = 0.005) and intrathoracic lymph nodes enlargement (p = 0.001) were significantly against the presence of common sensitising EGFR mutations.
These findings were further supported by the multivariate analysis: round contour [odd ratio (OR): 13.6, 95% confidence interval (CI): 1.40 - 13.2, p = 0.024], homogenous enhancement (OR: 2.5, 95% CI: 1.00 - 6.47, p = 0.049), presence of air bronchogram (OR: 2.7, 95% CI: 1.28 – 5.53, p = 0.009) and intrathoracic lymph nodes enlargement (OR: 0.2, 95% CI: 0.05 - 0.52, p = 0.002).
None of the CT features could differentiate exon 19 deletion from exon 21 L858R point mutation.
Table 1. CT- features of patients with sensitising EGFR mutation CT features All patients
(n = 158)Patients with EGFR mutation
(n = 67)p value* Multivariate analysis, OR (95% CI), p value A. Location Lobe, No. (%) Right upper lobe 58 26 (44.8) 0.643 Right middle lobe 11 5 (45.5) Right lower lobe 37 18 (48.6) Left upper lobe 35 11 (31.4) Left lower lobe 17 7 (41.2) Distribution, No. (%) Central 81 36 (44.4) 0.595 Periphery 77 31 (40.3) B. Size of primary tumour Long axis diameter, cm Mean (+ SD) 6.14 + 7.51 5.08 + 3.14 0.114 0.9 (0.86 - 1.02), 0.143 Short axis diameter, cm Mean (+ SD) 4.52 + 4.65 3.81 + 2.41 0.112 1.0 (0.70 - 1.44), 0.975 C. Shape Contour, No. (%) Round 8 7 (87.5) 0.029 13.6 (1.40 - 13.2), 0.024 Oval 3 1 (33.3) 0.1 (0.01 - 2.46), 0.175 Irregular/lobulation# 147 59 (40.1) D. Margin Border, No. (%) Well-defined 23 12 (52.2) 0.566 Mild-moderate ill-defined 35 15 (42.9) Ill-defined 100 40 (40.0) Spiculation, No. (%) Fine line from margin 46 22 (47.8) 0.556 Coarse line from margin 89 37 (41.6) None 23 8 (34.8) E. Contrast enhancement Enhancement, No. (%) Homogenous 34 20 (58.8) 0.029 2.5 (1.00 - 6.47), 0.049 Heterogenous# 120 47 (36.2) F. Attenuation Texture, No. (%) Solid 156 66 (42.3) 0.827 Part solid 2 1 (50.0) Pure ground glass 0 0 G. Internal Air bronchogram, No. (%) Yes 69 36 (61.0) 0.029 2.7 (1.28 – 5.53), 0.009 No# 89 31 (34.8) Cavitation, No. (%) Yes 13 6 (46.2) 0.775 No 145 61 (42.1) H. External Pleural/fissure attachment, No. (%) Yes 114 47 (41.2) 0.630 No 44 20 (45.5) Vascular convergence, No. (%) Yes 21 10 (47.6) 0.604 No 137 57 (41.6) Thickened bronchovascular, No. (%) Yes 88 32 (36.4) 0.085 1.3 (0.51 - 3.06), 0.620 No# 70 35 (50.0) Pleural retraction, No (%) Yes 87 36 (41.4) 0.773 No 71 31 (43.7) Peripheral emphysema, No. (%) Yes 39 9 (23.1) 0.005 0.5 (0.21 - 1.25), 0.144 No# 119 58 (48.7) Peripheral fibrosis, No. (%) Slight to moderate 64 30 (46.9) 0.643 Severe 10 4 (40.0) No 84 33 (39.3) I. Associated findings Intrathoracic lymph nodes enlargement, No. (%) Yes 135 50 (37.0) 0.001 0.2 (0.05 - 0.52), 0.002 No 23 17 (73.9) Vascular involvement, No. (%) Yes 79 32 (40.5) 0.678 No 79 35 (44.3) Lung metastases, No. (%) Nodule at primary lobe 6 2 (33.3) 0.823 Nodule at adjacent lobe 24 11(45.8) Nodule at contralateral lobe 78 35 (44.9) No 50 19 (38.0) Ipsilateral pleural effusion No. (%) Yes 68 34 (50.0) 0.105 2.0 (0.95 - 4.11), 0.069 No 89 33 (37.1) Contralateral pleural effusion, No. (%) Yes 18 7 (38.9) 0.895 No 140 60 (42.9) Distant metastases, N (%) Extrathoracic lymph node(s) 8 3 (37.5) Liver 7 2 (28.6) Bone 20 12 (60.0) Brain 3 1 (33.3) Other organs 48 21 (43.8) No 72 28 (38.9) *Chi-Square test for categorical variables; independent t-test for continuous variables.
#The last parameters are the references for multivariate analysis.
Conclusion
Tumours with round contour, homogenous enhancement and air bronchogram as well as absence of intrathoracic lymph nodes enlargement were independent predictors of the presence of common sensitising EGFR mutations. This information is helpful to clinicians in selecting best empirical treatment for patients who are not eligible for tissue biopsy and in those who need urgent treatment because of rapid clinical deterioration.
