Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
between 8 F-fluorodeoxyglucose (FDG) uptake of the primary tumor and
mediastinal lymph node metastasis (MLNM) in lung adenocarcinoma, and
to improve the diagnostic capability of tumor FDG uptake and other risk
factors in predicting occult MLNM preoperatively. Methods: We reviewed
360 consecutive pulmonary adenocarcinoma patients who underwent
preoperative PET/CT scan and subsequent surgery. Resected tumors were
classified according to the 2011 IASLC/ATS/ERS classification. Univariate and
multivariate analysis were conducted to evaluate the associations between
clinicopathological variables and MLNM. The receiver operating characteristic
(ROC) curve analysis was performed to quantify the predictive value of these
factors. Results: Of all the 360 patients, 54 were pathological N2 diseases.
On univariate analysis, CEA level, nodule type, nodal SUVmax, tumor
SUVmax, size, location and histologic subtype were associated with MLNM.
On multivariate analysis, CEA≥5.0 ng/ml (p < 0.001), solid nodule (p = 0.012),
tumor SUVmax ≥ 3.7 (p < 0.027), nodal SUVmax ≥ 2.0 (p < 0.001) and centrally
located tumors (p = 0.035) were independent risk factors that associated with
MLNM. The area under the ROC curve (AUC) for tumor SUVmax in predicting
MLNM was 0.764 and AUC of nodal SUVmax was 0.730. The combined use of
five factors yielded a higher AUC of 0.885 for N2 disease. The tumor SUVmax
among histologic subtypes differed significantly (p < 0.001). Conclusion:
Primary tumor SUVmax of PET/CT was shown a good predictor for MLNM
in patients with lung adenocarcinoma, and the underlying mechanism may
attribute to the close association between tumor FDG uptake and IASLC/
ATS/ERS adenocarcinoma subtypes. The combined use of tumor SUVmax
with factors like nodal SUVmax, solid nodule, centrally located tumor and
increased CEA level improved the diagnostic capacity for predicting N2
disease preoperatively.
Keywords: histologic subtype, lung adenocarcinoma, PET/CT, Mediastinal
lymph node metastasis
Nuclear Medine, Pet & Ultrasound, Westmead Hospital, Earlwood/NSW/Australia
Background: In patients with pulmonary malignancies, 18FDG uptake in
mediastinal nodes is a sensitive but non-specific indicator of metastatic
disease. The pattern of tracer uptake may improve the predictability of
such findings. Methods: To retrospectively i) compare 18FDG-PET scans and
EBUS findings in patients with documented pulmonary malignancies; and,
ii) compare the pattern of 18FDG uptake in mediastinal nodes in patients
with / without documented mediastinal node metastases. Methods: 62
patients with documented pulmonary malignancies underwent 18FDG-
PET scintigraphy followed by EBUS within the ensuing 3 weeks. One-two
nodes were assessed in each patient, determined by 18FDG-PET findings
and accessibility of the FDG-positive nodes. The mediastinal nodal status
from each procedure was compared. Results: EBUS resulted in mediastinal
nodal status downgrading in 25 (40%) patients. No upgrading was noted.
Downgrading most likely occurred when there several non-enlarged lymph
nodes of similar 18FDG-avidity distributed randomly and bilaterally in
the mediastinum, often with bilateral hilar uptake (17 of 25 patients).
Further, only 2 of 19 patients exhibiting such a pattern of mediastinal tracer
distribution were found to have lymph node metastases (10%), and both had
metastatic disease elsewhere on the PET scan. 21 of 23 patients with positive
EBUS findings demonstrated discrete 18FDG-avid lymph nodes ipsilaterally,
with minimal-to-no 18FDG-avid nodes contralaterally. EBUS findings in 14
(23%) patients were inconclusive, despite multiple sampling. Enlarged,
rounded lymph nodes with avid FDG uptake (SUV>4) were also more likely
to harbour metastatic disease. Conversely, a Hounsfield unit of >55 was
associated with benign disease. Conclusion: The pattern of mediastinal 18FDG
uptake was highly predictive of metastatic disease, and may circumvent the
need for EBUS evaluation. Prospective analysis of these parameters will be
undertaken.
Keywords: FDG-PET, Mediastinum, Staging, EBUS
POSTER SESSION 1 - P1.03: RADIOLOGY/STAGING/SCREENING
STAGING –
MONDAY, DECEMBER 5, 2016
P1.03-075 PREDICTIVE FACTORS FOR MINIMAL PLEURAL DISEASE
DETECTED AT THORACOTOMY OR POSITIVE LAVAGE CYTOLOGY
Akira Sakurada 1 , Fumihiko Hoshi 2 , Yoshinori Okada 1
1 Institute of Development, Aging and Cancer, Sendai/Japan, 2 Tohoku University
Hospital, Miyagi/Japan
Background: Minimal pleural disseminations and malignant pleural effusion is
eventually diagnosed at the therapeutic thoracotomy. Pleural lavage cytology
is another prognostic factor which is available through surgery. Although
CT image have become high quality, prediction of such pleural disease is still
difficult. To establish predictive markers for minimal pleural disease before
surgery will be useful for planning strategy for the patients with minimal
pleural disease. Methods: 115 patients who underwent pulmonary resection
in our hospital from January 2010 to December 2011 were retrospectively
analyzed for their clinicopathological information such as tumor marker CT
image, and histology. 65 were male and 50 female. Histology was squamous
cell carcinoma, adenocarcinoma, and other histology for 32, 78, and 5 cases,
respectively. Clinical staging according to WHO 7 th edition stage IA, IB, IIA, IIB,
and IIIA for 62, 31, 11, 3, and 8 cases, respectively. CT findings such as pleural
indentation and contact of tumor on pleura were carefully measured on
thin-slice CT sections with 0.5-1mm pitch. P value less than 0.05 was regarded
as statistically significance. Results: Eight cases were positive for pleural
disease, one for malignant effusion, 2 for minimal dissemination, and 6 for
pleural lavage cytology. By statistical analysis regarding association between
clinicopathological factors pleural disease, statistical positive factor was
tumor diameter and CEA positivity (P=0.037 and 0.01, respectively), but tumor
contact on pleura did not reach statistical significance (p=0.07). Pleural
indentation and histologic type was not statistically significant. Conclusion:
Based on current study, tumor diameter and serum CEA level could be possible
predictive factors for minimal pleural disease. Upon limited number of
patients, further study will be needed.
Keywords: pleural dissemination, pleural lavage cytology, CT, malignant
effusion
POSTER SESSION 1 - P1.03: RADIOLOGY/STAGING/SCREENING
STAGING –
MONDAY, DECEMBER 5, 2016
P1.03-076 NODAL STAGING OF PATIENTS WITH PULMONARY
MALIGNANCIES - THE PREDICTIVE VALUE OF DIFFERENT PATTERNS
OF MEDIASTINAL 18FDG-PET ACTIVITY
Socrates Angelides, Andrew Markewycz
POSTER SESSION 1 - P1.03: RADIOLOGY/STAGING/SCREENING
STAGING –
MONDAY, DECEMBER 5, 2016
P1.03-077 ANALYSIS OF THE EARLY CDT-BLOOD BIOMARKER FOR
LUNG CANCER IN HIGHER VS. LOWER RISK COHORTS
Melanie Ohillips 1 , Donald Rollins 2 , Debra Dyer 1 , Jeffrey Kern 1 , James Jett 1 ,
James Finigan 1
1 National Jewish Health, Denver/United States of America, 2 National Jewish Health,
Denver/AL/United States of America
Background: The Early Cancer Detection Test (CDT)-Lung Cancer Screening
(LCS) Study is a prospective, lung cancer screening study testing the
hypothesis that a serum biomarker consisting of a panel of seven cancerassociated
autoantibodies, in combination with a low-dose CT (LDCT),
would increase detection of early stage lung cancer. We analyzed nodules
rates and lung cancer in “higher risk” individuals who meet the USPSTF LCS
criteria (http://www.uspreventiveservicestaskforce.org/Page/Document/
UpdateSummaryFinal/lung-cancer-screening) and “lower risk” individuals
who do not meet these criteria. Methods: The EarlyCDT LCS study eligibility
criteria included persons 50-75 years of age, current or former smokers of ≥ 20
pack years, former smokers have ˂ 10 years since quit smoking. Additionally,
those with a history of lung cancer in first-degree relative(s) and any history of
smoking were also included. Exclusion criteria included any history of cancer
within 10 years (except skin cancer), any use of oxygen, or life expectancy < 5
years. The EarlyCDT-Lung test was considered positive if any one of the seven
autoantibodies was positive. Results: From May 2012 through June 2016,
1235 individuals were enrolled (final target 1600). The median age was 59
years, 55% were female and 45% were male. Fifty-two per cent were current
smokers while 48% were former smokers. Fifty-three percent of participants
were higher risk and 47% were lower risk. The EarlyCDT-Lung was positive in
8% of higher risk individuals and 6% of lower risk individuals. Thirty-five per
cent of higher risk individuals had nodules on LDCT while 27% of lower risk
participants had nodules on LDCT. The EarlyCDT-Lung blood test was positive
in 91 patients, 77 were higher risk and 34 were lower risk. There were 7 lung
cancers, all in the higher risk group, resulting in a lung cancer rate of 1.07% in
the higher risk group. The median pack years of individuals with lung cancer
was 60 and the median age was 64 years. Two of the 7 lung cancer patients
were positive for the EarlyCDT test. The relative risk of lung cancer in patients
with a positive EarlyCDT test was 5.5 for the entire cohort and 4.5 for the
higher risk group for lung cancer. Conclusion: There were more total nodules in
the higher risk group compared to the lower risk group. There were more lung
cancers in the higher risk group compared with the lower risk group. A positive
EarlyCDT test is associated with an increased risk of lung cancer.
Keywords: LDCT, Screening, biomarker
S304 Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017