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85P: Performance of EBUS-TBNA in NSCLC mediastinal staging stratified according to ACCP radiographic groups on CT
Abstracts, ELCC 2016
Journal of Thoracic Oncology Vol. 11, Suppl. 4S (2016) S92–S95
Imaging and staging 85P Performance of EBUS-TBNA in NSCLC mediastinal staging stratified according to ACCP radiographic groups on CT T. Edwards, H. Al-Najjar, P. Crosbie, J. Martin, R. Booton, M. Evison. North West Lung Centre, Wythenshawe Hospital-South Manchester University Hospitals Trust, Manchester, UK Background: The American College of Chest Physicians (ACCP) use radiographic groups based on Computed Tomography (CT) of the thorax to predict the probability of mediastinal nodal metastases and inform the need for pathological nodal staging. Group A is a peripheral tumour with a normal mediastinum, Group B a central tumour or N1 lymphadenopathy but normal mediastinum and Group C is discrete mediastinal lymphadenopathy. This study investigated the performance of EBUS-TBNA stratified by these radiographic groups. Methods: Prospective data is collected for all EBUS-TBNA procedures at out tertiary UK lung cancer centre. The radiographic group is recorded at the time of the procedure based on the index staging CT. EBUS-TBNA outcome data and subsequent data from mediastinoscopy, intra-operative lymph node sampling and 6 months of clinical-radiological follow-up is then recorded to allow calculation of performance (using the presence or absence of N2/3 disease as the denominator). This study is a retrospective analysis of the prospectively maintained database for the period 01/01/2014–31/12/2014. Results: See the table.
Number Prevalence of N2/3 Sensitivity Reasons for false negative procedure: Inaccessible nodes (5, 6, 8, 9) False negative sampling Accessible nodes not sampled
Group A
Group B
Group C
45 0% −
65 21% 43%
148 69% 86%
− − −
50% 50% −
33% 50% 12%
Conclusions: EBUS-TBNA is highly capable of identifying mediastinal disease in NSCLC patients with enlarged lymph nodes. This performance however does appear to reduce significantly in the radiologically normal mediastinum. This is not due to a lack of lymph node sampling but a combination of disease in lymph node stations inaccessible to EBUS and missing disease in nodes that have been sampled. Legal entity responsible for the study: University Hospitals of South Manchester Funding: Manchester Thoracic Oncology Centre Disclosure: All authors have declared no conflicts of interest.
86P Correlation between invasive size and solid component on CT evaluated with various conditions, and their impact on tumor aggressiveness Y. Sakao. Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan Background: It has been reported that pathological invasive size is more correlated with prognosis than that of tumor gross size. We analyzed the correlation between invasive size and solid component on CT evaluated with various conditions, and we analyzed the correlation between variables (invasive size, solid component on CT evaluated with various conditions) and invasiveness or lymph node metastasis. Methods: Between October 2013 and December 2014, 372 patients with lung adenocarcinomas underwent surgical resection at the Aichi Cancer Hospital. All tumors were examined using CT with thin section (1.0–2.0 mm) conditions on digital image data. We examined the patients’ thin-section chest CT images and their clinicopathological records. Tumor dimension was evaluated under two different CT imaging conditions: lung window settings [LW: level = −500 Hounsfield unit (HU), width = 1500 HU) and mediastinal window setting settings [MW: level = 60, width = 350 HU]. The CT images were evaluated for the maximum tumor dimension using LW (MLW), MW (MMW) and evaluated for the tumor maximum diameter of solid component in the tumor using LW (CLW). Tumor disappearance ratio (TDR) was defined as 1 − MMW/MLW and the solid component ratio (C/T) was define as maximum tumor diameter using CLW/MLW. Results: Correlation between invasive size and CT findings were as follows, MLW: 0.60, MMW: 0.65, CLW: 0.64, TDR: 0.41 and C/T: 0.62. Invasiveness: Invasiveness was defined as positive when any of lymph vessels(ly), vascular (v) or pleura (pl) was invaded by the tumor. The AUC evaluated with ROC were gross tumor size: 0.74, invasive size: 0.80, CLW: 0.82, C/T: 0.72, MMW: 0.83 and TDR: 0.77. In each of ly/v/pl, the MD showed the highest AUC among the variables. Lymph node metastasis: The AUC evaluated with ROC were gross tumor size: 0.57, invasive size: 0.80, CLW: 0.82, C/T: 0.72., MMW: 0.83 and TDR: 0.77. Conclusions: MMW and CLW were correlated with invasive size (R = 0.65 and 0.64). The tumor invasiveness or lymph node metastasis were highly correlated with MMW and CLW as well as invasive size. In adenocarcinoma, the solid component size on CT can be a clinical size (T) criteria because of its high correlation of invasiveness and lymph node metastasis. Legal entity responsible for the study: Aichi Cancer Center Ethical Board Funding: N/A Disclosure: All authors have declared no conflicts of interest.
Copyright © 2016 by the European Lung Cancer Conference organisers, ESMO and IASLC. Published by Elsevier Inc. All rights reserved.
Journal of Thoracic Oncology Vol. 11, Suppl. 4S (2016) S92–S95
Imaging and staging 85P Performance of EBUS-TBNA in NSCLC mediastinal staging stratified according to ACCP radiographic groups on CT T. Edwards, H. Al-Najjar, P. Crosbie, J. Martin, R. Booton, M. Evison. North West Lung Centre, Wythenshawe Hospital-South Manchester University Hospitals Trust, Manchester, UK Background: The American College of Chest Physicians (ACCP) use radiographic groups based on Computed Tomography (CT) of the thorax to predict the probability of mediastinal nodal metastases and inform the need for pathological nodal staging. Group A is a peripheral tumour with a normal mediastinum, Group B a central tumour or N1 lymphadenopathy but normal mediastinum and Group C is discrete mediastinal lymphadenopathy. This study investigated the performance of EBUS-TBNA stratified by these radiographic groups. Methods: Prospective data is collected for all EBUS-TBNA procedures at out tertiary UK lung cancer centre. The radiographic group is recorded at the time of the procedure based on the index staging CT. EBUS-TBNA outcome data and subsequent data from mediastinoscopy, intra-operative lymph node sampling and 6 months of clinical-radiological follow-up is then recorded to allow calculation of performance (using the presence or absence of N2/3 disease as the denominator). This study is a retrospective analysis of the prospectively maintained database for the period 01/01/2014–31/12/2014. Results: See the table.
Number Prevalence of N2/3 Sensitivity Reasons for false negative procedure: Inaccessible nodes (5, 6, 8, 9) False negative sampling Accessible nodes not sampled
Group A
Group B
Group C
45 0% −
65 21% 43%
148 69% 86%
− − −
50% 50% −
33% 50% 12%
Conclusions: EBUS-TBNA is highly capable of identifying mediastinal disease in NSCLC patients with enlarged lymph nodes. This performance however does appear to reduce significantly in the radiologically normal mediastinum. This is not due to a lack of lymph node sampling but a combination of disease in lymph node stations inaccessible to EBUS and missing disease in nodes that have been sampled. Legal entity responsible for the study: University Hospitals of South Manchester Funding: Manchester Thoracic Oncology Centre Disclosure: All authors have declared no conflicts of interest.
86P Correlation between invasive size and solid component on CT evaluated with various conditions, and their impact on tumor aggressiveness Y. Sakao. Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan Background: It has been reported that pathological invasive size is more correlated with prognosis than that of tumor gross size. We analyzed the correlation between invasive size and solid component on CT evaluated with various conditions, and we analyzed the correlation between variables (invasive size, solid component on CT evaluated with various conditions) and invasiveness or lymph node metastasis. Methods: Between October 2013 and December 2014, 372 patients with lung adenocarcinomas underwent surgical resection at the Aichi Cancer Hospital. All tumors were examined using CT with thin section (1.0–2.0 mm) conditions on digital image data. We examined the patients’ thin-section chest CT images and their clinicopathological records. Tumor dimension was evaluated under two different CT imaging conditions: lung window settings [LW: level = −500 Hounsfield unit (HU), width = 1500 HU) and mediastinal window setting settings [MW: level = 60, width = 350 HU]. The CT images were evaluated for the maximum tumor dimension using LW (MLW), MW (MMW) and evaluated for the tumor maximum diameter of solid component in the tumor using LW (CLW). Tumor disappearance ratio (TDR) was defined as 1 − MMW/MLW and the solid component ratio (C/T) was define as maximum tumor diameter using CLW/MLW. Results: Correlation between invasive size and CT findings were as follows, MLW: 0.60, MMW: 0.65, CLW: 0.64, TDR: 0.41 and C/T: 0.62. Invasiveness: Invasiveness was defined as positive when any of lymph vessels(ly), vascular (v) or pleura (pl) was invaded by the tumor. The AUC evaluated with ROC were gross tumor size: 0.74, invasive size: 0.80, CLW: 0.82, C/T: 0.72, MMW: 0.83 and TDR: 0.77. In each of ly/v/pl, the MD showed the highest AUC among the variables. Lymph node metastasis: The AUC evaluated with ROC were gross tumor size: 0.57, invasive size: 0.80, CLW: 0.82, C/T: 0.72., MMW: 0.83 and TDR: 0.77. Conclusions: MMW and CLW were correlated with invasive size (R = 0.65 and 0.64). The tumor invasiveness or lymph node metastasis were highly correlated with MMW and CLW as well as invasive size. In adenocarcinoma, the solid component size on CT can be a clinical size (T) criteria because of its high correlation of invasiveness and lymph node metastasis. Legal entity responsible for the study: Aichi Cancer Center Ethical Board Funding: N/A Disclosure: All authors have declared no conflicts of interest.
Copyright © 2016 by the European Lung Cancer Conference organisers, ESMO and IASLC. Published by Elsevier Inc. All rights reserved.