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P3.13-028 Controversies on Lung Cancers Manifesting as Part-Solid Nodules
S2326 it between 2 to 6 months. The average Medicare cost associated with patients that received PET was significantly higher than that of patients that did not receive PET scan ($60,417 vs. $34,287; p<0.001). Chemotherapy and radiation were given in a higher proportion of patients that received PET versus those that did not receive it (56% and 45% versus 26% and 36% respectively; p<0.001). Though univariate analysis revealed that a PET scan within a year of diagnosis was associated with better 1-year survival (HR 0.87, P<0.001), this did not translate into overall survival advantage on multivariable analysis (HR 0.99, P¼0.56). Conclusion: The utilization of PET scan in stage IV NSCLC patients was associated with higher cost, but without a tangible improvement in survival compared to those that did not have a PET scan. Keywords: SEER Medicare, Advance stage, PET
P3.13-028 Controversies on Lung Cancers Manifesting as PartSolid Nodules R. Yip,1 K. Li,2 L. Liu,1 D. Xu,1 K. Tam,1 D. Yankelevitz,1 B. Becker,3 E. Taioli,4 C. Henschke1 1Radiology, Icahn School of Medicine at Mount Sinai, New York, NY/US, 2Radiology, Fifth Affiliated Hospital of Sun YatSen University, Zhuhai/CN, 3Florida State University, Tallahassee, FL/US, 4 Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY/US Background: Questions have been raised about the appropriate treatment of lung cancers manifesting as subsolid nodules (nonsolid nodules (NSNs) and part-solid nodules (PSNs)), as these have very high reported survival rates and have been observed in up to 10% of screening participants. Our goal in this report is to summarize the publications on survival of patients with resected lung cancers manifesting as PSNs and to further the development of consensus definitions of the CT appearance and the workup of such nodules. Method: PubMed/MEDLINE and EMBASE databases were searched for all studies/ clinical trials on CT-detected lung cancer in English before Dec 21, 2015 to identify surgically-resected lung cancers manifesting as PSNs. Outcome measures were lung cancer-specific survival (LCS), overall survival (OS), or disease free survival (DFS). All PSNs were classified by the percentage of solid component to the entire nodule diameter into: Category PSNs <80% or Category PSNs 80%. Result: Twenty studies reported on PSNs <80%: 7 reported DFS and 2 OS of 100%, 6 DFS 96.3-98.7%, and 11 OS 94.7-98.9% (median DFS 100% and OS 97.5%). Twenty-seven studies reported on PSNs 80%: 1 DFS and 2 OS of 100%, 19 DFS 48.0%-98.0% (median 82.6%), and 16 reported OS 43.0%-98.0% (median DFS 82.6%, OS 85.5%). Both DFS and OS were always higher for PSNs<80%. Conclusion: A clear definition of the upper limit of solid component of a PSN is needed to avoid misclassification because cell-types and outcomes are different for PSN and solid nodules. The workup should be based on the size of the solid component. Keywords: ground-glass, survival, CT screening
P3.13-029 Imaging Guideline-Recommendations Prior to Treatment for Non-Small Cell Lung Cancer Demonstrates Variable Compliance J. Rayburn, C. Wilshire, C. Gilbert, B. Louie, R. Aye, A. Farivar, E. Vallieres, J. Gorden Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle/US Background: Poor adherence to the recommended guidelines in diagnosing and staging patients with non-small cell lung cancer (NSCLC), with negative downstream effects has been previously shown. In addition, studies have demonstrated benefits of staging with PET, including a reduction in number of non-curative resections performed
Journal of Thoracic Oncology
Vol. 12 No. 11S2
and a higher rate of identifying M1b disease. Staging with brain MRI has demonstrated a yield up to 10% for detecting metastasis in patients with negative clinical examinations. We aimed to assess the adherence to imaging guidelines for PET and brain MRI in the staging of NSCLC patients prior to treatment within our healthcare system. Method: We reviewed patients who underwent initial work-up for primary NSCLC during 6/2013e6/2015, in a hospital network of 7 institutions. Clinical stage II-IV patients were stratified by imaging performed prior to the initiation of treatment. Evidence-based clinical practice guidelines referenced include the American College of Chest Physicians (ACCP) 3rd edition and the National Comprehensive Cancer Network (NCCN) 7th version. Both ACCP and NCCN recommend a PET scan for suspected cIb-III; while ACCP recommends a brain MRI for suspected cIII-IV, and NCCN for suspected cIb-IV. Result: The Fig demonstrates compliance rates for the 283 included patients. Of cII patients, 7% (2/30) did not receive a PET scan and 43% (13/30) did not receive a brain MRI; while, 11% (6/56) of cIII did not receive a PET scan and 20% (11/56) did not receive a brain MRI. Conclusion: Variable compliance with imaging guidelines for the use of PET and brain MRI imaging for the staging of our NSCLC patients was seen. Lack of appropriate imaging for NSCLC staging may lead to inappropriate management decisions resulting from incomplete staging information. Quality initiatives are necessary to ensure guideline compliance.
P3.13-030 Metabolic Parameters of FDG PET at Early Evaluation of NSCLC Differ with Histological Subtypes Y. Landman,1 M. Nidam,2 L. Domachevsky,2 E. Dudnik,1 N. Peled,1 D. Groshar,2 H. Bernstein,2 A. Zer1 1Thoracic Cancer Service, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqwa/IL, 2Nuclear Medicine, Rabin Medical Center, Petah Tikva/IL Background: Fluorodeoxyglucose Positron emission tomography (FDG PET) is a main tool in diagnosis and staging in patients with non-small cell lung cancer (NSCLC). Metabolic parameters as standardized uptake value (SUV) and total lesion glycolysis (TLG) were reported to have independent prognostic and predictive value in different stages of disease and were shown to correlate with tumor activity and tumor burden. However, little is known regarding the correlation of these parameters with histologic subtypes of NSCLC. In this study we aimed to explore associations of FDG PET metabolic parameters in patients diagnosed with NSCLC and histologic subtypes of NSCLC. Method: We retrospectively evaluated 87 consecutive patients who underwent FDG PET scans in the workup of pulmonary nodules highly suspicious for malignancy. At total of 62 of them were found to have NSCLC; 44 with adenocarcinoma (ADC) and 18 with squamous cell carcinoma (SQCC). Measurements of hounsfield units (HU), region of interest (ROI), SUVmax, SUVmean, volume of interest (VOI) and TLG were obtained. Follow up for final staging at diagnosis and overall survival (OS) were obtained from electronic medical records. Statistical analysis was made with T-test and Mann-whitney u test. Result: In patients with SQCC, the mean ±standard deviation (SD) SUVmax and TLG (±SD) were found to be significantly higher than in patients with ADC (Table 1). Differences in OS showed a trend favoring SqCC but no significance was found
P3.13-028 Controversies on Lung Cancers Manifesting as PartSolid Nodules R. Yip,1 K. Li,2 L. Liu,1 D. Xu,1 K. Tam,1 D. Yankelevitz,1 B. Becker,3 E. Taioli,4 C. Henschke1 1Radiology, Icahn School of Medicine at Mount Sinai, New York, NY/US, 2Radiology, Fifth Affiliated Hospital of Sun YatSen University, Zhuhai/CN, 3Florida State University, Tallahassee, FL/US, 4 Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY/US Background: Questions have been raised about the appropriate treatment of lung cancers manifesting as subsolid nodules (nonsolid nodules (NSNs) and part-solid nodules (PSNs)), as these have very high reported survival rates and have been observed in up to 10% of screening participants. Our goal in this report is to summarize the publications on survival of patients with resected lung cancers manifesting as PSNs and to further the development of consensus definitions of the CT appearance and the workup of such nodules. Method: PubMed/MEDLINE and EMBASE databases were searched for all studies/ clinical trials on CT-detected lung cancer in English before Dec 21, 2015 to identify surgically-resected lung cancers manifesting as PSNs. Outcome measures were lung cancer-specific survival (LCS), overall survival (OS), or disease free survival (DFS). All PSNs were classified by the percentage of solid component to the entire nodule diameter into: Category PSNs <80% or Category PSNs 80%. Result: Twenty studies reported on PSNs <80%: 7 reported DFS and 2 OS of 100%, 6 DFS 96.3-98.7%, and 11 OS 94.7-98.9% (median DFS 100% and OS 97.5%). Twenty-seven studies reported on PSNs 80%: 1 DFS and 2 OS of 100%, 19 DFS 48.0%-98.0% (median 82.6%), and 16 reported OS 43.0%-98.0% (median DFS 82.6%, OS 85.5%). Both DFS and OS were always higher for PSNs<80%. Conclusion: A clear definition of the upper limit of solid component of a PSN is needed to avoid misclassification because cell-types and outcomes are different for PSN and solid nodules. The workup should be based on the size of the solid component. Keywords: ground-glass, survival, CT screening
P3.13-029 Imaging Guideline-Recommendations Prior to Treatment for Non-Small Cell Lung Cancer Demonstrates Variable Compliance J. Rayburn, C. Wilshire, C. Gilbert, B. Louie, R. Aye, A. Farivar, E. Vallieres, J. Gorden Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle/US Background: Poor adherence to the recommended guidelines in diagnosing and staging patients with non-small cell lung cancer (NSCLC), with negative downstream effects has been previously shown. In addition, studies have demonstrated benefits of staging with PET, including a reduction in number of non-curative resections performed
Journal of Thoracic Oncology
Vol. 12 No. 11S2
and a higher rate of identifying M1b disease. Staging with brain MRI has demonstrated a yield up to 10% for detecting metastasis in patients with negative clinical examinations. We aimed to assess the adherence to imaging guidelines for PET and brain MRI in the staging of NSCLC patients prior to treatment within our healthcare system. Method: We reviewed patients who underwent initial work-up for primary NSCLC during 6/2013e6/2015, in a hospital network of 7 institutions. Clinical stage II-IV patients were stratified by imaging performed prior to the initiation of treatment. Evidence-based clinical practice guidelines referenced include the American College of Chest Physicians (ACCP) 3rd edition and the National Comprehensive Cancer Network (NCCN) 7th version. Both ACCP and NCCN recommend a PET scan for suspected cIb-III; while ACCP recommends a brain MRI for suspected cIII-IV, and NCCN for suspected cIb-IV. Result: The Fig demonstrates compliance rates for the 283 included patients. Of cII patients, 7% (2/30) did not receive a PET scan and 43% (13/30) did not receive a brain MRI; while, 11% (6/56) of cIII did not receive a PET scan and 20% (11/56) did not receive a brain MRI. Conclusion: Variable compliance with imaging guidelines for the use of PET and brain MRI imaging for the staging of our NSCLC patients was seen. Lack of appropriate imaging for NSCLC staging may lead to inappropriate management decisions resulting from incomplete staging information. Quality initiatives are necessary to ensure guideline compliance.
P3.13-030 Metabolic Parameters of FDG PET at Early Evaluation of NSCLC Differ with Histological Subtypes Y. Landman,1 M. Nidam,2 L. Domachevsky,2 E. Dudnik,1 N. Peled,1 D. Groshar,2 H. Bernstein,2 A. Zer1 1Thoracic Cancer Service, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqwa/IL, 2Nuclear Medicine, Rabin Medical Center, Petah Tikva/IL Background: Fluorodeoxyglucose Positron emission tomography (FDG PET) is a main tool in diagnosis and staging in patients with non-small cell lung cancer (NSCLC). Metabolic parameters as standardized uptake value (SUV) and total lesion glycolysis (TLG) were reported to have independent prognostic and predictive value in different stages of disease and were shown to correlate with tumor activity and tumor burden. However, little is known regarding the correlation of these parameters with histologic subtypes of NSCLC. In this study we aimed to explore associations of FDG PET metabolic parameters in patients diagnosed with NSCLC and histologic subtypes of NSCLC. Method: We retrospectively evaluated 87 consecutive patients who underwent FDG PET scans in the workup of pulmonary nodules highly suspicious for malignancy. At total of 62 of them were found to have NSCLC; 44 with adenocarcinoma (ADC) and 18 with squamous cell carcinoma (SQCC). Measurements of hounsfield units (HU), region of interest (ROI), SUVmax, SUVmean, volume of interest (VOI) and TLG were obtained. Follow up for final staging at diagnosis and overall survival (OS) were obtained from electronic medical records. Statistical analysis was made with T-test and Mann-whitney u test. Result: In patients with SQCC, the mean ±standard deviation (SD) SUVmax and TLG (±SD) were found to be significantly higher than in patients with ADC (Table 1). Differences in OS showed a trend favoring SqCC but no significance was found