Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
asthma exacerbation in patients over 60 years old, the chest CT scan is a
recommended choice, or regularly reviewed by low dose CT screening to
discover lung cancer at early stage and improve prognosis. But the anti tumor
therapy of severe asthma combined with lung cancer patients is still a difficult
problem.
Keywords: clinical characters, asthma, lung cancer
POSTER SESSION 1 - P1.03: RADIOLOGY/STAGING/
SCREENING
Radiology –
MONDAY, DECEMBER 5, 2016
P1.03-012 EXPERIENCE WITH BIOSENTRYTM TRACT SEALANT
SYSTEM FOR PERCUTANEOUS CT-GUIDED LUNG NODULE BIOPSIES
IN AN ONCOLOGY POPULATION
Patricia De Groot 1 , Girish Shroff 2 , Judy Ahrar 2 , Garrett Gladish 1 , Bradley
Sabloff 1 , Cesar Moran 3 , Sanjay Gupta 2 , Joe Chang 4 , Gregory Gladish 1 , Jeremy
Erasmus 1
1 Unit 1478, UT MD Anderson Cancer Center, Houston/TX/United States of America,
2 UT MD Anderson Cancer Center, Houston/TX/United States of America, 3 U.T.-
M.D. Anderson Cancer Center, Surgical Pathology, Houston/TX/United States of
America, 4 Radiation Oncology, MD Anderson Cancer Center, Houston/United States
of America
Background: Tract sealants are being used more frequently to reduce
pneumothoraces and chest tube placement in patients undergoing lung
biopsy. Use of a sealant plug can produce visible biopsy tracts on followup
imaging and can mimic the appearance of malignant tract seeding. The
purpose of our study was to characterize these tracts and determine the
likelihood of malignant seeding to inform further management including
localized radiation therapy and/or surgical planning. Methods: Over a 15
month period 407 lung biopsies were performed in patients with known or
suspected thoracic and extrathoracic malignancies using a BioSentry Tract
Sealant System; 321 cases had follow up CT studies. 4 chest radiologists
retrospectively analyzed subsequent imaging to determine the incidence,
appearance, temporal relationship and evolution of biopsy tracts. Tracts
that decreased or did not change on follow-up were considered benign. 10
surgically resected cases were retrospectively examined by a pathologist
for malignant tract seeding. Results: 321 cases were analyzed. 237 (74%) had
a visible biopsy tract on CT (95%CI 0.69, 0.78) (primary lung cancer n=90,
metastases n=81, benign nodule n=66). All tracts were identified on 1st followup
imaging at 1-3 months post-biopsy. Tracts were typically serpiginous and
smooth or lobulated with a thickness of 2-5 mm. 218/237 (92%) tracts were
unchanged over time (mean follow up, 12 months). 15/237 (6.3%) decreased
in thickness. Unchanged or decreasing tracts were considered negative for
malignant seeding. Increase in tract thickness or nodularity occurred in
4/237 (1.8%), suspicious for malignant tract seeding. 0/90 (0%) biopsy tracts
in primary lung cancer showed progressive increase. 4/81 (4.9%) tracts in
patients with metastases showed increase (mean, 99 days post-biopsy). 10
resected nodules (5 primary NSCLCs, 5 metastases) had no malignant tract
seeding at histology. Conclusion: An observable biopsy tract on CT is common
after lung biopsy using the BioSentry TM device. Tracts from biopsy of primary
lung cancers using the BioSentry device had no malignant seeding and they
should have no impact on surgical resection or localized radiation therapy.
In the study population, patients who underwent lung biopsy for metastasis
had a higher than expected rate of malignant seeding manifested by increased
track thickness over time, requiring further investigation.
Keywords: Biopsy tract, Lung biopsy, Malignant tract seeding, Biopsy tract
sealant
POSTER SESSION 1 - P1.03: RADIOLOGY/STAGING/SCREENING
RADIOLOGY –
MONDAY, DECEMBER 5, 2016
P1.03-013 DIAGNOSIS, ASSESSMENT AND PREDICTION OF EARLY
RESPONSE TO CHEMOTHERAPY BY USING DIFFUSION-WEIGHTED
MRI IN LUNG CANCER
Long-Biao Cui 1 , Hong Yin 1 , Jian Zhang 2
1 Department of Radiology, Xijing Hospital, Fourth Military Medical University,
Xi’An/China, 2 Department of Pulmonary Medicine, Xijing Hospital, Fourth Military
Medical University, Xi’An/China
Background: Radiographic screening, diagnosing, staging, and assessing
procedures with ironizing radiation-based tests are currently most widely
used for lung cancer. However, one of the major harms of these imaging tests
is the potential for radiation-induced carcinogenesis. Whether radiographic
screening, diagnosing, staging, and assessing procedures increase cancer
incidence and death in patients exposed to radiation of medical sources
is ignored in the context of indefinite answer. We aimed to evaluate the
ability of radiation-free diffusion-weighted magnetic resonance imaging
(DW-MRI) to diagnose, assess and detect early response to chemotherapy in
lung cancer patients. Methods: This study was approved by the institutional
review board, and written informed consent was obtained from all subjects.
Ninety patients with lung cancer as confirmed by pathologic examination
(25 women, 65 men; mean age, 57 years) who underwent chemotherapy were
enrolled between November 2014 and October 2015. All patients underwent
MRI and computed tomography (CT), as the reference test, at baseline and
after the second course of chemotherapy. The apparent diffusion coefficient
(ADC) of each lung carcinoma was calculated from images. Ki-67 scores and
tumor markers in the serum, carcinoembryonic antigen (CEA), neuron-specific
enolase (NSE) and squamous cell carcinoma antigen (SCC), were determined.
ADC values were compared among different histopathologic types and
between pretreatment and posttreatment. Receiver operating characteristic
(ROC) analysis was performed to evaluate the diagnostic performance of
ADC and its combination with tumor markers. The relationship between the
baseline ADC values with Ki-67 scores and final tumor size reduction were
analyzed by using the Pearson correlation coefficient. This study is registered
with Clinical Trials.gov (NCT02320617). Results: Before treatment, there were
significant differences between NSCLC and SCLC (P=0.000), adenocarcinoma
and SCLC (P=0.000), and squamous cell carcinoma and SCLC (P=0.002). ADC
values and Ki-67 score showed negative correlation (r=−0.408, P=0.000). In
ROC analysis, area under curve (AUC) of ADC in combination with CEA, SCC and
NSE was 0.772, 0.821 and 0.761, respectively. ADC values were significantly
different between pretreatment and posttreatment (P=0.001), and partial
response (PR) and stable disease (SD) groups. ADC at baseline was negatively
correlated with tumor size reduction (r=−0.434, P=0.017). As well, AUC of ADC
after treatment to discriminate PR and SD groups was 0.804. Conclusion: Our
findings extended the previous findings by that ADC in DW-MRI could: (1)
discriminate different histopathologic types; (2) evaluate the malignancy; (3)
predict and monitor the early response to chemotherapy. Radiation-free DW-
MRI seems to be a promising tool for management of lung cancer.
Keywords: lung cancer, diffusion-weighted magnetic resonace imaging,
diagnosis, chemotherapy
POSTER SESSION 1 - P1.03: RADIOLOGY/STAGING/SCREENING
RADIOLOGY –
MONDAY, DECEMBER 5, 2016
P1.03-014 VALUE OF PERFORMING FINE NEEDLE ASPIRATION
WITH CORE BIOPSY FOR GENOMIC MUTATION ASSESSMENT IN
PERCUTANEOUS LUNG BIOPSIES
Sharjeel Sabir, Livia Maria Frota Lima
MD Anderson Cancer Center, Houston/TX/United States of America
Background: Personalized care of lung cancer patients requires determination
of targetable genetic mutations. This study was performed to investigate the
added value of performing fine needle aspiration (FNA) with core biopsy in
percutaneous lung biopsy to assess clinically relevant genomic mutations in
EGFR, KRAS and BRAF. ALK mutation was assessed separately through FISH,
which was not assessed in this study. Methods: Retrospective analysis of all
CT-guided lung biopsies in lung cancer patients with samples sent for next
generation sequencing (NGS) with a 50-gene multiplex panel during 2013 and
2014. Procedures were performed using 19 gauge coaxial guides, 20 gauge sidecutting
core needles and 22 gauge Chiba needles. Samples were processed for
histological evaluation. The remaining material was reviewed for adequate
tumor cellularity (>20%) by pathology. If the specimen collected through
core biopsy did not present adequate tumor cellularity, the FNA material was
reviewed and sent for mutation analysis. DNA was extracted and sequenced
with a 50-gene multiplex platform (Ion Torrent Personal Genome Machine).
If the samples were not adequate for NGS, single gene sequencing was
performed for the requested genetic mutations. Patient demographic, lesion
imaging features, procedure technique and molecular results were collected.
Descriptive statistics were tabulated. Results: A total of 188 patient met the
criteria for this study. 184 patients had FNA and core biopsy together and 4
had only FNA. 19 out of 184 (10.32%) core biopsy specimen had