Diagnosis Of Primary Lung Cancer Research Articles

Is histological confirmation necessary to avoid futile resections? Comparative of 4 university hospitals.

There is no consensus in the literature on preoperative histological analysis for lung cancer. The objective of this study was to assess 4 diagnostic models used in different hospitals with differing practices regarding preoperative histological diagnosis and the consequences in terms of unnecessary surgery and futile major resection. We carried out a retrospective observational study collected from 4 university hospitals in Spain over 3 years (January 2019 to December 2021). We included all patients with a confirmed diagnosis of primary lung cancer and any patients with suspected primary lung cancer who had undergone surgery. All patients underwent computed tomography and positron emission tomography/computed tomography scans. Each multidisciplinary committee was free to choose whether to perform flexible bronchoscopic or transthoracic lung biopsy. Decisions concerning whether to perform intraoperative sample analysis, the surgical approach and the type of resection were left to the surgical team. We included a total of 1642 patients. The use of flexible endoscopy and its diagnostic performance varied substantially between hospitals (range: 23.8-79.3% and 25-60.7%, respectively); and the same was observed for transthoracic biopsy and its performance (range: 16.9-82.3% and 64.6-97%, respectively). Regarding major resection surgery (lobectomy or more extensive resection), the lowest rate was observed in hospital C (1%) and the highest in hospital B (2.8%), with between-hospital differences not reaching significance (P = 0.173). The rate of histological sampling before lung cancer surgery still varies between hospitals. In spite of very diverse multidisciplinary management, the rate of futile lobectomy is not significantly higher in hospitals with lower rates of preoperative histological analysis.

The insufficiency of CT examination in early detection of central lung squamous cell carcinoma and squamous epithelial precancerous lesions

BackgroundCT examination for lung cancer has been carried out for more than 20 years and great achievements have been made in the early detection of lung cancer. However, in the clinical work, a large number of advanced central lung squamous cell carcinoma are still detected through bronchoscopy. Meanwhile, a part of CT-occult central lung squamous cell carcinoma and squamous epithelial precancerous lesions are also accidentally detected through bronchoscopy.MethodsThis study retrospectively collects the medical records of patients in the bronchoscopy room of the Endoscopy Department of Zhejiang Cancer Hospital from January 2014 to December 2018. The inclusion criteria for patients includes: 1.Patient medical records completed, 2.Without history of lung cancer before the diagnosis and first pathological diagnosis of primary lung cancer, 3.Have the lung CT data of the same period, 4.Have the bronchoscopy records and related pathological diagnosis, 5.The patients undergoing radical surgical treatment must have a complete postoperative pathological diagnosis. Finally, a total of 10,851 patients with primary lung cancer are included in the study, including 7175 males and 3676 females, aged 22–98 years. Firstly, 130 patients with CT-occult lesions are extracted and their clinical features are analyzed. Then, 604 cases of single central squamous cell carcinoma and 3569 cases of peripheral adenocarcinoma are extracted and compares in postoperative tumor diameter and lymph node metastasis.Results115 cases of CT-occult central lung squamous cell carcinoma and 15 cases of squamous epithelial precancerous lesions are found. In the total lung cancer, the proportion of CT-occult lesions is 130/10,851 (1.20%). Meanwhile, all these patients are middle-aged and elderly men with a history of heavy smoking. There are statistically significant differences in postoperative median tumor diameter (3.65 cm vs.1.70 cm, P < 0.0001) and lymph node metastasis rate (50.99% vs.13.06%, P < 0.0001) between 604 patients with operable single central lung squamous cell carcinoma and 3569 patients with operable peripheral lung adenocarcinoma. Of the 604 patients with squamous cell carcinoma, 96.52% (583/604) are male with a history of heavy smoking and aged 40–82 years with a median age of 64 years.ConclusionsThis study indicates that the current lung CT examination of lung cancer is indeed insufficiency for the early diagnosis of central squamous cell carcinoma and squamous epithelial precancerous lesions. Further bronchoscopy in middle-aged and elderly men with a history of heavy smoking can make up for the lack of routine lung CT examination.

Efficacy of Robotic Bronchoscopy for Molecular Marker Analysis in Primary Lung Cancer

BackgroundMolecular testing has become a more frequent necessity in NSCLC management. Using next-generation sequencing, multiple targets for therapy can be identified with small amounts of nuclear material. The authors evaluated the performance of robotic-assisted bronchoscopy in acquiring tissue that meets pre-analytic criteria for PD-L1 immunohistochemistry and/or next-generation sequencing. Materials and MethodsPatients with a diagnosis of primary lung cancer identified through robotic bronchoscopy were retrospectively reviewed. Pathology reports were assessed for results of molecular testing and detection of programmed death-ligand 1 (PD-L1). An independent pathologist evaluated each specimen type (smears, cell block, tissue biopsy, and/or touch prep) to determine whether each tissue type would meet pre-analytic criteria for attempting next-generation sequencing and/or PD-L1 immunohistochemistry. ResultsSeventy-eight patients with primary lung were reviewed. By independent pathologic assessment of cytological smears, cell block, biopsy, and/or touch preparations, 72% of samples were found to be adequate for molecular and PD-L1 testing. Preanalytic adequacy (%) for next-generation sequencing (NGS) and PD-L1 staining was determined based on specimen type: cytological smear 48.6% for NGS; cell block 14.3% for NGS and 32.9% for PD-L1; biopsy 29.2% for NGS and 62.5% for PD-L1; and touch prep 61.4% for NGS. ConclusionRobotic-assisted bronchoscopy yielded samples that met preanalytic criteria for molecular testing in 72% of cases. These results support the use of robotic-assisted bronchoscopy for both the diagnosis and molecular testing of early-stage lung cancer.

EGFR Mutation Detection in Brazilian Patients With Non-Small-Cell Lung Cancer: Lessons From Real-World Data Scenario of Molecular Testing.

There is a paucity of consistent data concerning genetic mutations in Brazilian patients with lung cancer. The aim of this study was to retrospectively analyze epidermal growth factor receptor (EGFR) mutations detected in a real-world scenario using a large cohort of Brazilian patients with non-small-cell lung cancer (NSCLC). This was a cross-sectional, observational, descriptive study on the basis of a database of EGFR molecular analysis from tumor samples of patients with a confirmatory histopathological diagnosis of primary lung cancer. Specimens were collected from 2013 to 2017 and were tested using cobas, next-generation sequencing, and Sanger sequencing platforms. A total of 7,413 tumor specimens were tested. The patients were predominantly women with a median age of 67.0 years. Patients with at least one mutation represented 24.2% of the total sample. Among the positive patients, the majority had just one mutation, but two or more simultaneous mutations were observed in 1.52% of patients. Exon 19 deletion was the most prevalent alteration in the sample (12.8%), followed by exon 21 L858R (6.9%) and exon 20 insertion (1.6%). All others were considered uncommon mutations and were observed in 18.5% of all mutated patients and 4.0% of the total sample (2.3%-18.7% depending on the sequencing method). This study examined the prevalence of EGFR mutations in Brazilian patients with NSCLC using different technologies, suggesting that the type of method used, directed or nondirected against specific mutations, influences the analysis, particularly for uncommon mutations, which will be missed by mutation-specific approaches such as cobas testing. Our estimates are the largest in Latin America and are consistent with previous reports from other parts of the world. Besides the variability in methods described here as technology incorporation advances in a nonhomogeneous manner, it is probably like the real-world clinical setting Brazilian oncologists face in their daily practice.

Typical carcinoid in right middle lobe of pulmonary hypoplasia

BackgroundPulmonary typical carcinoid occurring in hypoplasia of the right middle lobe is very rare.Case presentationA routine examination's chest X-ray revealed an abnormal shadow in the right middle lung field of an 82-year-old Japanese woman. A chest computed tomography scan showed a solid 2.5 × 2.0-cm nodule in the very small right middle lobe. A trans-bronchial lung biopsy of the mass in the right middle lobe was performed; it revealed atypical cells with round nuclei growing in multiple foci, and immunostaining was positive for chromogranin A, synaptophysin and CD56, suggesting pulmonary carcinoid. The preoperative clinical diagnosis of primary lung cancer, cT1cN0M0 stage IA3 was considered. A right middle lobectomy and mediastinal lymph node dissection were performed by video-assisted thoracic surgery. Intraoperatively, the middle lobe of the right lung was very small, with 1- to 2-mm-dia. pulmonary arteries and veins that were considered hypoplastic. The final histopathological diagnosis was typical carcinoid, pT2aN0M0 stage IB based on the presence of pleural invasion.ConclusionsIncluding the present patient, only nine cases of lung cancer occurring within pulmonary hypoplasia have been reported, most of which were typical carcinoid.

Diagnosis of primary lung cancer and benign pulmonary nodules: a comparison of the breath test and 18F-FDG PET-CT.

With the application of low-dose computed tomography in lung cancer screening, pulmonary nodules have become increasingly detected. Accurate discrimination between primary lung cancer and benign nodules poses a significant clinical challenge. This study aimed to investigate the viability of exhaled breath as a diagnostic tool for pulmonary nodules and compare the breath test with 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)-computed tomography (CT). Exhaled breath was collected by Tedlar bags and analyzed by high-pressure photon ionization time-of-flight mass spectrometry (HPPI-TOFMS). A retrospective cohort (n = 100) and a prospective cohort (n = 63) of patients with pulmonary nodules were established. In the validation cohort, the breath test achieved an area under the receiver operating characteristic curve (AUC) of 0.872 (95% CI 0.760-0.983) and a combination of 16 volatile organic compounds achieved an AUC of 0.744 (95% CI 0.7586-0.901). For PET-CT, the SUVmax alone had an AUC of 0.608 (95% CI 0.433-0.784) while after combining with CT image features, 18F-FDG PET-CT had an AUC of 0.821 (95% CI 0.662-0.979). Overall, the study demonstrated the efficacy of a breath test utilizing HPPI-TOFMS for discriminating lung cancer from benign pulmonary nodules. Furthermore, the accuracy achieved by the exhaled breath test was comparable with 18F-FDG PET-CT.

Implementation of a housing insecurity screening tool in patients with lung cancer.

e18601 Background: Patients with lung cancer experiencing housing insecurity are known to have longer time to biopsy, more missed appointments, and other delays in treatment as compared to their peers with stable housing. Methods: A single-institution retrospective chart review was performed at our safety-net academic institution. Patients with a new diagnosis of primary lung cancer from January 2015 through December 2020 who responded to the housing insecurity screening tool were included. Patients who screened positive received a print-out of housing resources or referral to a patient navigator. All characteristics except molecular testing were analyzed using multivariate logistic regression with housing status as the dependent variable. Molecular testing was analyzed separately via a Chi-Square test of independence given molecular testing was indicated for only a subset of patients. Results: Of the 423 patients, 264 (62%) reported housing insecurity. Compared to patients with stable housing, patients with housing insecurity received molecular testing when indicated at comparable rates, had similar time from first biopsy to initiation of treatment, and had similar insurance status (Table 1). Patients with stable housing were more likely to be White (OR 1.65, 95% CI 1.09 -2.50). Conclusions: Although existing data shows patients with housing insecurity experience delays in treatment, our findings suggest that provision of equitable access to care with targeted interventions to reduce housing insecurity may help reduce such disparities, which often affect minoritized racial groups disproportionately. [Table: see text]

Electronic patient-reported outcomes in a cohort of patients with lung cancer treated in the community with shorter versus longer course PD1/PDL1 therapy.

e18810 Background: PD1/PDL1 (IO) therapy has been extensively studied as monotherapy and in combination with other IO therapy, chemotherapy and targeted agents. The side effect profile in the clinical trial setting in lung cancer has been extensively cataloged. However, patient-reported symptoms in the real world have not been evaluated and may help inform reasons for patient discontinuation of therapy or adverse clinical events. Methods: Patients from 3 community oncology practices were eligible for inclusion in the study if they had a primary diagnosis of lung cancer, started IO therapy (either monotherapy or in combination with chemotherapy) between Sep 2020 and June 2022 (with follow-up through Dec 31, 2022), and submitted at least 2 ePRO reports during treatment. We examined ePRO reports submitted by patients using a proprietary commercially available ePRO tool. Reports were categorized as high risk if they exceeded a clinical threshold for severity defined by the practices. We also examined the reporting profile by therapy type, and further stratified by time on treatments ( &lt; 6 versus 6+ months of therapy). Results: There were 172 patients included in the analysis. Over this time frame, 68 patients received IO monotherapy and 104 received IO plus chemotherapy. Of these patients, 51% were male and 64% were 65+ years of age. Overall, 68 patients received less than 6 months of therapy and 104 patients received more than 6 months of therapy. There were 3159 reports submitted (1087 within the first 60 days of treatment) with a median of 13 reports per patient. Patients receiving IO plus chemotherapy reported more severe symptoms (symptom severity of 3 or greater on a 5-point scale) within the first 60 days of treatment than those receiving IO monotherapy (51% vs 34%, p = 0.03, Chi square). Regardless of treatment type, patients receiving &lt; 6 months of therapy were more likely to report severe symptoms during this time period as compared to those on treatment for 6 months or longer (Table). 50% of reports triggered an alert based on severity, 22% led to a phone call and 1.3% an emergent office visit. Conclusions: ePROs can identify common side effects in lung cancer patients receiving IO monotherapy and IO/chemotherapy combinations. Early symptoms may define a population at high risk of early discontinuation. Aggressively managing these patients might result in a longer duration of therapy and better clinical outcome. [Table: see text]

Association of Weight Loss in Ambulatory Care Settings With First Diagnosis of Lung Cancer in the US

Lung cancer, the US's leading cause of cancer death, is often diagnosed following presentation to health care settings with symptoms, and many patients present with late-stage disease. To investigate the association between weight loss and subsequent diagnosis of incident lung cancer in an ambulatory care population and to assess whether recorded weight change had higher odds of lung cancer diagnosis than objective measurements. This case-control study included patients visiting a US academic medical center between January 1, 2012, and December 31, 2019. Data were derived from US ambulatory care electronic health records from the University of Washington Medical Center linked to the local Surveillance, Epidemiology, and End Results cancer registry. Cases were identified from patients who had a primary lung cancer diagnosis between 2012 and 2019; controls were matched on age, sex, smoking status, and presenting to the same type of ambulatory clinic as cases. Data were analyzed from March 2022 through January 2023. Continuous and categorical weight change were assessed. Odds ratios estimating the likelihood of a diagnosis of lung cancer were calculated using univariable and multivariable conditional logistic regression. A total of 625 patients aged 40 years or older with a first primary lung cancer diagnosis and 4606 matched controls were included (1915 [36.6%] ages 60 to 69 years; 418 [8.0%] Asian, 389 [7.4%] Black, 4092 [78.2%] White). In unadjusted analyses, participants with weight loss of 1% to 3% (odds ratio [OR], 1.12; 95% CI, 0.88-1.41), 3% to 5% (OR, 1.36; 95% CI, 0.99-1.88), or 5% to 10% (OR, 1.23; 95% CI, 0.82-1.85) over a 2-year period did not have statistically significantly increased risk of lung cancer diagnosis compared with those who maintained a steady weight. However, participants with weight loss of 10% to 50% had more than twice the odds of a lung cancer diagnosis (OR, 2.27; 95% CI, 1.27-4.05). Most categories of weight loss showed significant associations with an increased risk of lung cancer diagnosis for at least 6 months prior to diagnosis. Patients who had weight loss both recorded in clinicians' notes and measured had higher odds of lung cancer compared with patients who had only recorded (OR, 1.26; odds; 95% CI, 1.04-1.52) or measured (OR, 8.53; 95% CI, 6.99-10.40) weight loss. In this case-control study, weight loss in the prior 6 months was associated with incident lung cancer diagnosis and was present whether weight loss was recorded as a symptom by the clinician or based on changes in routinely measured weight, demonstrating a potential opportunity for early diagnosis. The association between measured and recorded weight loss by clinicians presents novel results for the US.

A Validated Register-Based Algorithm to Identify Patients Diagnosed with Recurrence of Surgically Treated Stage I Lung Cancer in Denmark.

Recurrence of cancer is not routinely registered in Danish national health registers. This study aimed to develop and validate a register-based algorithm to identify patients diagnosed with recurrent lung cancer and to estimate the accuracy of the identified diagnosis date. Patients with early-stage lung cancer treated with surgery were included in the study. Recurrence indicators were diagnosis and procedure codes recorded in the Danish National Patient Register and pathology results recorded in the Danish National Pathology Register. Information from CT scans and medical records served as the gold standard to assess the accuracy of the algorithm. The final population consisted of 217 patients; 72 (33%) had recurrence according to the gold standard. The median follow-up time since primary lung cancer diagnosis was 29 months (interquartile interval: 18-46). The algorithm for identifying a recurrence reached a sensitivity of 83.3% (95% CI: 72.7-91.1), a specificity of 93.8% (95% CI: 88.5-97.1), and a positive predictive value of 87.0% (95% CI: 76.7-93.9). The algorithm identified 70% of the recurrences within 60 days of the recurrence date registered by the gold standard method. The positive predictive value of the algorithm decreased to 70% when the algorithm was simulated in a population with a recurrence rate of 15%. The proposed algorithm demonstrated good performance in a population with 33% recurrences over a median of 29 months. It can be used to identify patients diagnosed with recurrent lung cancer, and it may be a valuable tool for future research in this field. However, a lower positive predictive value is seen when applying the algorithm in populations with low recurrence rates.

Trends in hospitalization and in-hospital mortality rates among patients with lung cancer in Spain between 2010 and 2020

BackgroundLung cancer is the third most frequent tumor and the main cause of death by tumor in Spain. Although the incidence and mortality are still significantly higher in men than in women, the disparity between the sexes is decreasing. The objective of this study was to analyze the evolution of lung cancer hospitalization and in-hospital mortality rates in Spain from 2010 to 2020.MethodsThe reports of the Minimum Basic Data Set (MBDS) at hospital discharge were used to retrospectively analyze the data of all patients with a primary diagnosis of lung cancer, according to the International Classification of Diseases (ICD-9-CM and ICD-10-CM).ResultsBetween 2010 and 2020, there were 315,263 hospitalizations and 70,490 deaths from lung cancer in Spain, the majority (~ 80%) in men. Overall, the rates of hospitalization and in-hospital mortality from lung cancer showed a downward trend throughout the period, although the number of new diagnoses and the absolute number of deaths in women increased. Due to the aging of the population, the degree of comorbidity in patients with lung cancer, although it remains relatively low, is also on the rise.ConclusionLung cancer represents a substantial clinical and economic burden for patients and for the National Health System, so it is necessary to promote primary prevention campaigns, as well as to develop more effective population screening measures to detect cancers early and increase the patient survival.

Prostate Adenocarcinoma With Atypical Immunohistochemistry Presenting With a Cheerio Sign

The most common cancer in men is prostate cancer. The Cheerio sign is the computed tomography finding of multiple pulmonary nodules with central lucency resembling the ring-shaped Cheerio breakfast cereal. Unlike bone metastasis, pulmonary involvement is less common. The Cheerio sign has malignant and benign etiologies. Thyroid transcription factor-1 (TTF-1) stain is commonly used in the diagnosis of primary lung cancer. TTF-1 positivity in cancers of prostate origin is rare, with only case reports and small case series available in the literature. Metastatic prostate cancer presenting with a Cheerio sign has not been reported in the literature.

A novel diagnostic model for differentiation of lung metastasis from primary lung cancer in patients with colorectal cancer.

This study aimed to evaluate the 18F-FDG PET/CT in differentiating lung metastasis(LM) from primary lung cancer(LC) in patients with colorectal cancer (CRC). A total of 120 CRC patients (80 male, 40 female) who underwent 18F-FDG PET/CT were included. The diagnosis of primary lung cancer or lung metastasis was based on histopathology The patients were divided into a training cohort and a validation cohort randomized 1:1. Independent risk factors were extracted through the clinical information and 18F-FDG PET/CT imaging characteristics of patients in the validation cohort, and then a diagnostic model was constructed and a nomograms was made. ROC curve, calibration curve, cutoff, sensitivity, specificity, and accuracy were used to evaluate the prediction performance of the diagnostic model. One hundred and twenty Indeterminate lung lesions (ILLs) (77 lung metastasis, 43 primary lung cancer) were analyzed. No significant difference in clinical characteristics and imaging features between the training and the validation cohorts (P > 0. 05). Using uni-/multivariate analysis, pleural tags and contour were identified as independent predictors. These independent predictors were used to establish a diagnostic model with areas under the receiver operating characteristic curves (AUCs) of 0.92 and 0.89 in the primary and validation cohorts, respectively. The accuracy rate of the diagnostic model for differentiating LM from LC were higher than that of subjective diagnosis (P < 0.05). Pleural tags and contour were identified as independent predictors. The diagnostic model of ILLs in patients with CRC could help differentiate between LM and LC.

A Large Single Institution Analysis of Disparities in Genomic Testing in Lung Cancer Patients

<h3>Purpose/Objective(s)</h3> There has been an increase in genomic testing in lung cancer patients which has helped guide treatment and improve outcomes. However, there is an underrepresentation of racial and ethnic minority groups in many genomic sequencing studies. The disparate use of genomic testing could contribute to and widen health care disparities, as well as, limit the generalizability of findings. The purpose of this study was to determine the demographic of lung cancer patients that undergo genomic sequencing at our institution across a diverse health system. <h3>Materials/Methods</h3> A retrospective analysis of patients presenting to our institution with a pathology diagnosis of primary lung cancer and demographic date entered into SEMA4 biorepository database between December 2004 and January 2022 was performed. Demographic, clinical presentation, treatment, staging, and genomic testing (e.g., hotspot or targeted panels) were evaluated. Statistical analysis was performed using descriptive statistics, standard t-test, chi-square, Fisher's exact test, univariate and multivariate logistic regression. <h3>Results</h3> In total, 5729 patients met inclusion criteria for this study. Of these patients, 37.2% (2134) had genomic testing and 62.8% (3595) did not have testing. Mean ages of 75.9 in non-tested cohort and 72.7 years in tested cohort (p<0.001). The tested cohort was 55.4% (1182) female versus 51.5% (1851) in the non-tested cohort (p=0.004). In the tested cohort, there was lower proportion of white patients (p=0.001), but higher proportion of Asian (p=0.0001), other (p=0.0001) and unknown race patients (p=0.0001), as well as, non-Hispanic ethnicity (p=0.001). There were 835 (14.6%) patients overall that received radiation therapy (RT), with a higher proportion of tested patients receiving RT (20.0% vs 11.4%, p=0.0001). On multivariate logistic regression, the odds of testing decreased with older age (CI 0.98-0.99, p<0.001) and male sex (CI 0.74-0.93, p=0.001). The odds increased if patients were any race other than white non-Hispanic, including black non-Hispanic (CI 1.88-2.75, p=0.03), black Hispanic (CI 1.12-6.40, p<0.001), Asian (CI 3.01-5.67, p<0.001), and other race (CI 1.50-2.05, p<0.001) patients. The odds of genomic testing did not change if patients were white Hispanic (p=0.94) or Pacific Islander (p=0.30). <h3>Conclusion</h3> In contrast to previously published literature, there was not an underrepresentation of racial and ethnic minorities in patients who underwent genomic testing. In fact, patients who received SEMA4 testing were generally racially and ethnically diverse. Patients that were younger, female sex, and Asian race were significantly more likely to undergo testing. In order to mitigate health care disparities, there needs to be a concerted effort to recruit underserved, diverse populations to identify full range of genetic variation and appropriate targeted therapies.

MR-Guided Online Adaptive Stereotactic Body Radiotherapy (SBRT) of Primary and Metastatic Lung Tumors

<h3>Purpose/Objective(s)</h3> Radiotherapy has an important role in management of lung tumors. Online adaptive radiotherapy is a method that provides dosimetric accuracy by considering anatomical and functional changes with real-time images taken during treatment, and MR-guided radiotherapy is the latest technological development in this field. In our study, we aimed to present preliminary results and toxicity in patients who underwent magnetic resonance (MR) guided online adaptive radiotherapy (MRgRT) for primary or metastatic lung tumors. <h3>Materials/Methods</h3> Fifty-one patients with a diagnosis of primary lung cancer or lung metastases treated with MRgRT and a minimum follow-up period of 3 months were included. The treatment was carried out with the "step-and-shoot" IMRT technique and daily online adaptive planning. All patients were treated with breath-hold with audio-visual coaching. Patients were evaluated for treatment response, acute and late toxicity. <h3>Results</h3> The median age was 64 (range, 22-83 years) and 68.6% of the patients were male. MRgRT was performed in 21.6% of the patients for primary lung cancer and 78.4% for lung metastases from different primaries. MRgRT was applied to a single lesion in 38 patients and more than one lesion in 13 patients (a total of 69 lesions). Tumors were peripherally located in 78.3% of the patients and 21.7% of lesions were in the "no-fly zone". Median GTV volume was 1.8 cc (range, 0.2-172.1 cc). Target volume and doses of organs at risk met the criteria in all initial plans. Online adaptive treatment approach was applied in all patients. The median total dose was 50 Gy (range, 24-70), the median fraction number was 5 (range, 1-15 fractions), and the median fraction dose was 10 Gy (range, 4-34). The patients were treated every other day, except for two patients treated with 10 and 15 fractions. Median follow-up was 18.7 months. One- and 3-year overall survival (OS) rates were 92.4% and 68.0%, respectively. During the follow-up period, complete response was obtained in the MRgRT applied lesions in 37 patients, partial response was observed in 8 patients and local recurrence or progression was detected in 6 patients. One- and 3- year local progression free survival (LPFS) and distant progression free survival (DPFS) rates were 97.3%, 67.1% and 36.4%, 13.0%, respectively. There were no statistically significant differences in OS, LPFS and DPFS between primary and metastatic tumors. No Grade 3+ acute or late toxicity was observed. <h3>Conclusion</h3> In conclusion, MRgRT is a new method for the application of SBRT with better soft tissue contrast, no need for invasive marker placement, online adaptive radiotherapy in every fraction, and continuous real-time cine-MR tumor tracking. Our study shows that MRgRT is an acceptable method for the treatment of lung tumors. Randomized prospective studies with longer follow-up are needed comparing this technique with other modalities.

Impact of pulmonary hypertension on lung cancer management

IntroductionThe diagnosis and management of lung cancer is challenging among patients followed-up for pulmonary hypertension (PH). Many interventional procedures are not suitable for severely ill patients, thus limiting the diagnosis and treatment of cancer. We report on patients diagnosed with both conditions in our Institution. MethodsWe conducted a retrospective observational cohort study at Toulouse University Hospital. We analysed both management and outcome for patients followed-up for precapillary PH following diagnosis of primary lung cancer. ResultsOut of 764 patients followed-up for PH, 25 went on to develop bronchopulmonary neoplasia. The median age was 69 years with a predominance of males (56%) and smokers (92%). Fifty-two percent had group 1 PH and 36% severe group 3 PH. The comorbidity burden was high and 76% were oxygen-dependent. Twenty-eight percent of patients were considered ineligible for tissue biopsy, the diagnosis being made by a multidisciplinary team (MDT) based on radio-clinical presentation. Fifty-four percent of patients did not benefit from any treatment. Sixteen percent of pulmonary diagnostic procedures were associated with complications (severe hypoxaemia, intra-alveolar hemorrhage, haemothorax). Patients were undertreated compared to disease stage guidelines (2 surgical procedures for 9 localised stages). Median survival after cancer diagnosis was 6 months. ConclusionThe management of lung cancer is complex in PH patients. The high rate of complications during the diagnosis and therapy steps coupled with very poor patient outcome for both conditions should prompt physicians to thoroughly discuss the benefit/risk benefit in each case.

Landscape of pathogenic germline variants in patients with lung cancer.

388570 Background: Few studies have aimed to investigate the prevalence and spectrum of pathogenic germline variants (PGVs) in patients diagnosed with lung cancer. Given the growing opportunities for precision therapies based on PGVs in DNA damage-repair (DDR)/homologous recombination-repair (HRR) genes and the importance of identifying PGVs to inform future cancer screening and cascade testing, we investigated the prevalence and potential clinical implications of PGVs in individuals with lung cancer. Methods: Deidentified data were retrospectively reviewed for 7,788 individuals diagnosed with lung cancer for whom germline DNA sequencing and exon-level copy number analysis were performed between 2014-2022 at a commercial diagnostic laboratory. The diagnosis of lung cancer was based on ICD-10 codes or language on the test requisition suggesting a primary lung cancer diagnosis. Individuals with requisitions suggesting lung metastases, neuroendocrine tumors or sarcomas as the basis for testing were excluded. Number of genes tested varied per ordering clinician preference. Clinically actionable PGVs were defined as those associated with clinical management recommendations or trial eligibility per current, standard of care guidelines. Descriptive statistics were utilized. Results: The cohort was predominantly female (71.1%), White (64.5%), and most had a history of &gt; 1 cancer (71.1%). A median of 79 genes (range 1-159) were tested. Testing identified 1,503 PGVs in 81 known cancer-risk genes in 1,161/7,788 (14.9%) patients; an additional 229 (2.9%) patients carried a single PGV in a gene associated with autosomal recessive inheritance. PGV rates stratified by self-reported ancestry: Black/African American, 11.8%; Asian or Pacific Islander, 11.8%; Hispanic, 14.5%; White, 15.4%. Among genes with &gt;1,000 individuals tested, PGVs were most common in BRCA2 (2.8%), CHEK2 (2.1%), ATM (1.9%), TP53 (1.3%), BRCA1 (1.2%), and EGFR (1.0%). Of 1,161 individuals, 712 (61.3%) had a PGV in a DDR/HRR gene, making them potentially eligible for a clinical treatment trial, and 1,104/1,161 (95.1%) had a PGV that was potentially clinically actionable. Conclusions: From this large cohort of individuals with lung cancer, 14.9% had PGVs, nearly all of which were clinically actionable. Notably, HRR PGVs were common (64%). Currently, the U.S. Food and Drug Administration has approved and the National Comprehensive Cancer Network Guidelines endorse targeted therapies for patients with breast, pancreatic, prostate, and ovarian cancers who carry HRR PGVs. Recently, the NCCN Guidelines panel recommended germline testing be considered for all patients diagnosed with colorectal cancer. Given the profound implications for both patients and their families that result from identifying PGVs, our results suggest that all patients with lung cancer also be considered for germline genetic testing.

Study on primary non-small cell lung cancer with special reference to immunohistochemistry, EGFR mutation and K-RAS mutation in a tertiary care hospital

Background: In lung cancers the use of immunohistochemistry is recommended for those cases in which diagnosis is unclear between adenocarcinoma and squamous cell carcinoma. This study is to know the different mutations in NSCLC of the lungs in our tertiary care centre. Aims &amp; Objectives: To study clinical and radiological correlation with different histological types of primary lung cancer with refence to immunohistochemistry TTF-1 and p63 and to detect EGFR, KRAS mutation. Material &amp; Methods: The study was conducted in a tertiary care centre of Odisha during the period from Sept. 2019 to Sept. 2021. 40 patients of age &gt;18yrs with strong clinical suspicion and/or chest radiographic diagnosis of primary lung cancer are included in this study from IPD of Pulmonary Medicine Department, SCB MCH, Cuttack after taking into account inclusion and exclusion criteria. Results: Most of the cases were in the 5th &amp; 6th decade of age with mean age of 58.8yrs. Most males (57.5%) in the study were smoker and all females were Never-Smokers. EGFR mutation found in 7 cases out of 20 Adenocarcinoma (35%) and 2 cases out of 19 Squamous cell carcinomas (10.5%). K-RAS mutation was detected in 1 adenocarcinoma patient (5%).

Findings of virtual bronchoscopic navigation can predict the diagnostic rate of primary lung cancer by bronchoscopy in patients with peripheral lung lesions

BackgroundDespite being minimally invasive, bronchoscopy does not always result in pathological specimens being obtained. Therefore, we investigated whether virtual bronchoscopic navigation (VBN) findings were associated with the rate of diagnosis of primary lung cancer by bronchoscopy in patients with peripheral lung lesions.MethodsThis study included patients with suspected malignant peripheral lung lesions who underwent bronchoscopy at St. Luke’s International Hospital between October 2013 and March 2020. Patients diagnosed with primary lung cancer were grouped according to whether their pathology could be diagnosed by bronchoscopy, and their clinical factors were compared. In addition, the distance between the edge of the lesion and the nearest branch (“distance by VBN”) was calculated. The distance by VBN and various clinical factors were compared with the diagnostic rates of primary lung cancer.ResultsThe study included 523 patients with 578 lesions. After excluding 55 patients who underwent multiple bronchoscopies, 381 patients were diagnosed with primary lung cancer. The diagnostic rate by bronchoscopy was 71.1% (271/381). Multivariate analysis revealed that the lesion diameter (odds ratio [OR] 1.107), distance by VBN (OR 0.94) and lesion structure (solid lesion or ground-glass nodule; OR 2.988) influenced the risk of a lung cancer diagnosis. The area under the receiver operating characteristic curve for diagnosis based on lesion diameter and distance by VBN was 0.810.ConclusionThe distance by VBN and lesion diameter were predictive of the diagnostic rates of primary lung cancer by bronchoscopy in patients with peripheral lung lesions.

Anti-CK7/CK20 Immunohistochemistry Did Not Associate with the Metastatic Site in TTF-1-Negative Lung Cancer.

Anti-CK7 and anti-CK20 immunohistochemistry is sometimes used to establish a diagnosis of primary lung cancer. We performed a retrospective study on the value of anti-CK7 and anti-CK20 immunohistochemistry in 359 biopsies of patients with suspected lung carcinoma in order to assess the usefulness of these antibodies in the evaluation of lung tumors in biopsies. Our results showed TTF-1 positivity in 73.3% of patients. EGFR mutations and ALK rearrangements were significantly different between TTF-1 positive and TTF-1 negative tumors (p < 0.001 and p = 0.023, respectively). Our results show a significant difference (p < 0.001) between TTF-1 positive and TTF-1 negative carcinomas with a median survival of 21.97 months (CI95% = 17.48–30.9 months) and 6.52 months (CI95% = 3.34–10.3 months), respectively. In the group of TTF-1 negative patients, anti-CK7 and CK20 immunohistochemistry was performed in 70 patients and showed CK7+/CK20- staining in 61 patients (87.1%), CK7-/CK20- in 4 patients (5.7%), CK7+/CK20+ in 3 patients (4.3%), and CK7-/CK20- in 2 patients (2.8%). No specific or molecular pattern was found in these groups of CK7/CK20 combinations. In total, this work brings arguments concerning the uselessness of anti-CK7/CK20 immunohistochemistry in the case of suspicion of primary lung cancer in biopsies.