Diagnosis Of Primary Lung Cancer Research Articles

Multiple Primary Tumors in Patients with Anal Squamous Cell Carcinoma in the SEER Cancer Registry

Increased risk of a second primary malignancy (SPM) before or after the diagnosis of anal squamous cell carcinoma (ASCC) in patients has been reported in a previous single-institution study of 46 patients. We hypothesize that patients diagnosed with ASCC are at increased risk for developing second cancers. Here, we present a large-scale report of incidences of cancers diagnosed prior to or after a diagnosis of ASCC using data from the US population-based SEER registries. We employed the SEER registry data to conduct a US-population based study which included patients diagnosed with ASCC who survived a previous primary malignancy as well as patients who first receive a diagnosis of ASCC and then developed another malignancy. In patients diagnosed with ASCC who survived for a minimum of 2 months, we evaluated the risk of subsequent cancers and the risk of developing ASCC as a second primary. Standardized incidence ratios (SIR) were calculated for all secondary cancers by using the ratio of observed to expected (O/E) second cancers. The expected number of cancers is calculated for a matched reference cohort. Confidence intervals and p-values are at 0.05 significance alpha levels and two-sided based on Poisson exact methods. All analyses were conducted with statistical program SEER∗Stat version 8.3.5 provided by the National Cancer Institute utilizing the multiple primary SIR tool. Our data is selected from the SEER 9 Registries November 2018 submission using cancers reported between 1975-2016 (n = 3,600,102). The baseline cohort for this analysis consists of individuals diagnosed with primary ASCC (n = 7,594). We found that these patients were at increased risk of diagnosis with a second primary malignancy (∼13%); of these, cancers of the lung, oropharynx, vulva, oropharynx, or a second anal/colon cancer predominated. In patients diagnosed with primary ASCC, excess risk (ER) for a second primary diagnosis of lung cancer in men was calculated to be 36.52 and in women was 23.67. The risk of a second cancer in the colon/rectum/anus in men was elevated (ER = 21.42). In women, vulvar cancer carried the second-highest risk of second primary diagnosis (ER = 10.02). We also determined that patients diagnosed with ASCC had an increased rate of previous malignancy (∼17%), most commonly Kaposi sarcoma or vulvar cancer. For men, ER of ASCC after Kaposi sarcoma diagnosis was 11.61. In women, increased risk was associated with a first primary diagnosis of vulvar cancer (ER = 4.91). Our findings support increased surveillance and screening for second malignancies in patients with these cancer diagnoses, as patients with ASCC are often either survivors of a prior cancer diagnosis or are at increased risk of developing later malignancies. This could be related to chronic immunosuppression from cancer therapy or mediated by Human Papilloma Virus.

Feasibility study of cryobiopsy for practical pathological diagnosis of primary lung cancer including immunohistochemical assessment.

Precision medicine in non-small cell lung cancer requires attainment of a sufficient amount of high-quality tumor tissue. Transbronchial cryobiopsy has emerged as a new diagnostic method for non-neoplastic lung disease with a better potential to assess morphology compared with conventional methods. However, the influence of cryobiopsy on specimen quality, particularly detection of protein expression, is unknown. We performed a comparative immunohistochemical study in specimens obtained by cryobiopsy versus conventional sampling to evaluate the feasibility of cryobiopsy for lung cancer diagnosis. Pairs of artificial biopsy specimens, collected using a cryoprobe or conventional scalpel, were obtained from 43 surgically resected primary lung tumors. Formalin-fixed, paraffin-embedded blocks were prepared in an ISO15189-certified laboratory. Immunohistochemical staining of thyroid transcription factor-1, p40, Ki67 and programmed death-ligand 1 (22C3) was performed. The H-scores for thyroid transcription factor-1 and p40, labeling index for Ki67 and tumor proportion score for programmed death-ligand 1 were assessed. Pearson's correlation coefficients between two sampling types were calculated. The thyroid transcription factor-1 and p40 H-scores showed perfect correlations between the cryobiopsy and conventional scalpel-obtained specimens (R2=0.977 and 0.996, respectively). Ki67 labeling index and PD-L1 tumor proportion score also showed strong correlations between the two sample types (R2=0.896 and 0.851, respectively). Five cases (11.6%) exhibited differences in tumor proportion score category between sample types, potentially because of intratumoral heterogeneity. Immunohistochemical expression of certain tumor markers showed a high concordance between cryobiopsy and conventional scalpel sampling. Cryobiopsy is feasible for pathological diagnostics including PD-L1 evaluation.

Lung cancer risk and residential radon exposure: A pooling of case-control studies in northwestern Spain

BackgroundThrough a pooled case-control study design, we have assessed the relationship between residential radon exposure and lung cancer risk. Other objectives of the study were to evaluate the different risk estimates for the non-small cell lung cancer histological types and to assess the effect modification of the radon exposure on lung cancer risk by tobacco consumption. MethodsWe collected individual data from various case-control studies performed in northwest Spain that investigated residential radon and lung cancer. Cases had a confirmed anatomopathological diagnosis of primary lung cancer and controls were selected because they were undergoing ambulatory evaluation or surgical procedures that were unrelated to tobacco use. Residential radon was measured using alpha track detectors. Results were analyzed using logistic regression. Results3704 participants were enrrolled, 1842 cases and 1862 controls. Data show that lung cancer risk increases with radon exposure, finding a significant association of radon exposure with lung cancer at radon exposures above 50 Bq/m3. The estimated adjusted OR for individuals exposed to concentrations >200 Bq/m3 was 2.06 (95% CI: 1.61–2.64) compared with those exposed to ≤50 Bq/m3. Within a smoking category, lung cancer risk increases markedly as radon concentration increases, reaching an OR of 29.3 (95% CI: 15.4–55.7) for heavy smokers exposed to more than 200 Bq/m.3 ConclusionsThis study confirms that residential radon exposure is a risk factor for lung cancer well below action levels established by international organizations. As expected, there is also an effect modification between radon exposure and tobacco consumption.

Clinical Utility of Combined Circulating Tumor Cell and Circulating Tumor DNA Assays for Diagnosis of Primary Lung Cancer.

Although it has been suggested that circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA) might be used in a complementary manner in lung cancer diagnosis, limited confirmatory data are available. In this prospective study, we evaluated the diagnostic performance of each assay separately and in combination. From March 2018 to January 2019, patients with suspected primary lung cancer, who underwent routine lung cancer work-up and peripheral blood sampling, were prospectively enrolled in the study. Epithelial cell adhesion molecule and cytokeratin served as markers of CTCs. In terms of ctDNA analysis, single-nucleotide variants were evaluated via next-generation sequencing. We analyzed 111 patients, including 99 with primary lung cancer and 12 with benign pulmonary disease. The median number of CTCs in 10 ml of blood was 3. The most frequently detected single nucleotide variants of ctDNA were TP53, CDKN2A, and EGFR. The diagnostic sensitivity of conventional tumor marker (combination of carcinoembryonic antigen/CYFRA 21-1/neuron-specific enolase) was 66.7%, while those of the ctDNA and CTC assays were 72.7% and 65.7%, respectively. The sensitivity of the CTC/ctDNA combination (95.0%) was significantly greater than those of the CTC (p<0.001), ctDNA (p<0.001), or conventional tumor marker (p<0.001) alone. Subgroup analysis revealed that the sensitivity of the combination assay was greater than those of the CTC or ctDNA assays alone, regardless of tumor stage or histopathology type. The CTC/ctDNA combination assay enhanced the sensitivity of primary lung cancer diagnosis. The combination assay strategy may be clinically useful and could enhance the early detection of lung cancer (ClinicalTrials.gov number: NCT03479099).

Delayed diagnosis of lung cancer due to misdiagnosis as worsening of sarcoidosis: a case report

BackgroundThe concurrence of sarcoidosis and primary lung cancer is very rare. We report a very rare case with a delayed diagnosis of primary lung cancer due to its misdiagnosis as worsening of pulmonary sarcoidosis.Case presentationA 68-year-old man presented to the outpatient department for evaluation of a mass in the right hilar area with lymphadenopathies in subcarinal and both interlobar areas on chest computed tomography (CT). Sufficient core samples were obtained from subcarinal and bilateral interlobar lymph nodes using endobronchial ultrasonography (EBUS) guided transbronchial needle aspiration (TBNA). EBUS could not reach the right hilar lymph node due to its high angle. The pathologic findings were consistent with sarcoidosis. After 5 months, chest CT revealed aggravation of the right upper paratracheal lymphadenopathy. Assuming worsening of sarcoidosis, he was prescribed an oral corticosteroid for 5 months. However, follow-up chest CT showed a newly developed right lower paratracheal lymphadenopathy and worsening right hilar lymphadenopathy. Bronchoscopy and EBUS were performed once again. Transbronchial lung biopsy from the right upper lobe and EBUS-TBNA from the right lower paratracheal lymph node revealed adenocarcinoma from the lung.ConclusionsAlthough coexistence of sarcoidosis and lung cancer is very rare, the clinician should consider the possibility of accompanying lung cancer in sarcoidosis patients who are not responding to initial corticosteroid therapy.

Pulmonary scarring and its relation to primary lung cancer.

Background Lung scar carcinoma, so called ‘scarcinoma’, is a perceived entity that was originally described by Friedrich in 1939, in which a carcinoma originates from peripheral scarring of lung tissue. In a recent pilot study, there was a strong association between the geographic location of lung cancer and the presence of scarring of the lung. Objectives To investigate this relationship in the largest cohort to date. Methods We reviewed all radiological images of patients (N=917) with confirmed lung cancer from 2013 - 2017 and included all who had at least a staging computed tomography (CT) of the chest and a tissue diagnosis of primary lung cancer. Two pulmonary specialists categorised all patients as no pulmonary scarring, scarring in the same lobe, scarring in the ipsilateral lung, but not lobe, scarring in the contralateral lung and diffuse scarring both lungs. Results Almost 1 in 3 patients had pulmonary scarring. In patients with lung cancer, if scarring was present, the pulmonary scarring was more likely to be found in the same lobe as the cancer compared with any other lobe, including the same lung (p<0.0001). Conclusion Pulmonary scarring was common, and there was a strong association between the geographical location of scarring and primary lung cancer in those with scarring.

Epidemiology of lung cancer in northeast of Iran: A 25-year study of 939 patients.

Background: Lung cancer (LC) is a global public health priority. In this study, the epidemiology and current trends of primary LCs were investigated in northeast of Iran. Methods: Demographic and pathologic records of primary LCs during 1985-2012 in Mashhad (capital of northeast of Iran) were reviewed. Data were obtained from archives of the largest referral oncologic hospital and the only private outpatient radiation-oncologic clinic in the region. To investigate trends, study duration was classified into 3 periods: 1985-1995, 1995-2005, and 2005-2012. Patients were placed in one of these 3 groups, based on the date of their pathologic diagnosis. Data were analyzed by SPSS 16 software. T test, chi-squared, and ANOVA tests were used for data analysis, and statistical significant level was set at < 0.05. Results: Among 939 cases with pathologic diagnosis of primary LC, male-to-female ratio was 2.36. Mean±SD age at diagnosis was 61.47±12.01 years in males and 58.45±12.75 in females (p=0.001). Squamous cell carcinoma (SCC) was the most frequent pathologic subtype. Mean age at diagnosis and rate of smokers were unchanged during the study (p= 0.978 and 0.153, respectively). Relative frequency of leading pathologic subtypes changed in 3 intervals (p<0.001): it was increasing in adenocarcinoma and large cell carcinoma and decreasing in SCC and small cell lung cancer (SCLC). There were statistically significant differences in the mean age at diagnosis (p<0.001), rate of smokers (p<0.001), and male-to-female ratio (p=0.011) between leading pathologic subtypes. Conclusion: Similar to universal picture, rate of adenocarcinoma in northeast of Iran was rising during recent decades, especially among younger patients, women, and nonsmokers. These trends are indicative of changes in exposures and smoking habits and reveal the need for regional studies in these contexts.

Clinicopathological profile of primary lung cancer in a tertiary care teaching hospital in the south-east coast of India

Introduction: Lung is one of the commonest sites for neoplasms both primary and metastatic cancers. Identification and determination of histopathological play a major role in the diagnosis and treatment of cancer. Radiology and imaging helps in the selection of procedures to obtain a tissue sample for the diagnosis and management of lung cancer. The present study was aimed to analyze the clinic-pathological profile of primary lung cancer in the south-east coast of India. Materials and Methods: A prospective, observational study was conducted in the Department of Pulmonary Medicine, Maharaja Institute of Medical Sciences (MIMS), Vizianagaram, Andhra Pradesh, India. A total of 104 patients with primary lung cancer were enrolled. Radiological, clinico pathological profile and Histopathological analysis was done individually for all patients. Results: Male patients (70.1%) were more compared to females (29.9%). The Average age of the study population was 57.8 years. A total of 70(67.3%) study subjects had a history of smoking comprising of 61 males and 9 female subjects. Almost all study patients had clinical presentations of cough and shortness of breath (100%). Most common X-ray and CT chest radiographic feature was mass lesion (n=89 and n=91). Adenocarcinoma was identified in 79 patients (76.0%) as the most common histological type and it was also common in both smokers (n=49) and nonsmokers (n=29). Conclusions: The most common histological variant was Adenocarcinoma followed by squamous cell carcinoma. Among men, smoking is the principal risk factor in the causation of lung cancer. A precise, accurate and rapid screening method is still warranted for the diagnosis of primary lung cancer. Keywords: Adenocarcinoma, Bronchoscopy, Clinico-pathological profile, Histopathological profile, Primary lung cancer.

150P - Liquid biopsy assays using combined circulating tumour cells and circulating tumour DNA in the same patients for the diagnosis of primary lung cancer

BackgroundLung cancer is the most common cause of cancer-related mortality worldwide. Early diagnosis and surgery may be one of the most important strategy for the treatment of lung cancer patients. However, the procedure of lung cancer diagnosis from initial suspicion to final confirmation is not efficient due to low sensitivity of current diagnostic methods and difficulties involved in tumor tissue biopsy in lung cancer compared to other cancer types. Therefore, we investigated the feasibility of liquid biopsy using circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA) analysis for the better diagnosis of lung cancer. MethodsIn this study, we blindly analyzed both CTCs and ctDNA in the blood samples derived from 109 patients including histology-proven and clinically suspicious lung cancer patients to test the sensitivity of liquid biopsy methods. CTC analysis was done by CytoGen’s liquid biopsy platform, in which viable CTCs were isolated by size-based filtration with gravity and validated by immunostaining of EpCAM or CK, excluding CD45 positive cells and enumerated by CytoGen’s cell imaging software. Lung cancer diagnosis was predicted by a cut-off, 2 ≥ CTC in 5ml peripheral blood. For ctDNA analysis, EDGC F-Can platform was used to analyze single nucleotide variations of very low variant allele frequencies by utilizing unique molecular indexes and a novel read error correction algorithm. For comparison, we also analyzed the levels of conventional tumor markers (CEA, cyfra21-1 and NSE) in the patient cohort. ResultsCompared to the diagnostic sensitivities of conventional tumor markers (CEA 29%; cyfra21-1 41%; NSE 39%), both assays of CTCs and ctDNA showed higher diagnostic sensitivity in predicting primary lung cancer (CTCs 67%; ctDNA 83%). When the assays of CTCs and ctDNA were combined for the diagnosis, the sensitivity was increased up to 98%. ConclusionsCollectively, this study suggests that combined CTCs and ctDNA assay would be useful for the diagnosis of primary lung cancer. Legal entity responsible for the studyCytogen, Inc., EDGC, Inc., Department of Medicine, Samsung Medical Center FundingHas not received any funding DisclosureAll authors have declared no conflicts of interest.

EP1.17-08 Good Survival in Females Undergoing Surgery Without Adjuvant Chemotherapy for Stage Three Lung Cancer: A Review of Our 12-Year Experience

Lung cancer is a major disease in Singapore. Anatomical surgical resection is the treatment of choice for early lung cancer. No study on outcome of surgery on early lung cancer has been reported in a mixed Asian population. We aim to review the outcome of patients with early lung cancer who underwent surgery in our tertiary centre. We performed a retrospective cross-sectional study on all patients who underwent lung resection between 1st January 2006 and 31st December 2017. Information collected included patient”s age, gender, race, stage of disease and outcome data. Those with a diagnosis of primary lung cancer were included whilst those whose surgery was not for curative intent were excluded. 404 patients are included in our study. The mean age is 62.9 years with the modal age group between 60 and 69 years old. Females are significantly younger than males (mean 61.6 years vs 64.0 years, p = 0.019). 76.6% (n = 310) are early disease (Stage 1 or Stage 2) and 20.0% (n = 81) are late disease (Stage 3). Overall survival is significantly higher in early than late disease and in females than males. In female patients with Stage 3 disease, there is no significant difference in 1-year survival between early (97.3%) and late (89.7%) (p = 0.177) disease. Those aged between 70 and 79 years has a significantly higher mortality at 3 years (27.3%, odds ratio 3.73 (1.0 – 13.5, CI 95%)). There is no significant difference in 3 year mortality between early and late disease in females younger than 60 years old (87.5% vs 77.8%, p = 0.303). T3/T4 disease patients have better survival rates than N2 disease patients. All female patients with T3/T4 disease are still alive at 5 years even in those without adjuvant chemotherapy. In females with N2 disease, 3 and 5-year survival is also higher in patients with partial or no adjuvant chemotherapy but this is not statistically significant. The use of adjuvant chemotherapy is also associated with a significant higher rate of recurrence (53.5% vs 16.1%, p = 0.001) in all patients with Stage 3 disease, especially in female patients (68.2% vs 18.2%, p = 0.009). In females with N2 disease, the recurrence rate is significantly higher in those who had adjuvant chemotherapy (68.4% vs 25.0%, p = 0.049). For those with T3/T4 disease, there is no recurrence in patients who did not have any adjuvant chemotherapy but this is not statistically significant. Our study demonstrate that female patients with early lung cancer present earlier and have significant higher survival rates than males. Even in patients with stage 3 disease, there is good survival benefit up to 3 years post-surgery for patients aged 60 years old and below. Three and five year survival are better in female patients with N2 disease who did not have or did not complete their adjuvant chemotherapy than those who did. The use of adjuvant chemotherapy is also associated with a higher rate of recurrence, especially in females with N2 disease.

2766 An Atypical Case of Metastatic Lung Cancer Presenting as Abdominal Pain and Anemia

INTRODUCTION: Lung cancer is the second most common cancer in both men and women. In 2019, the United States estimate number of lung cancer cases are 228,150 resulting in 142,670 deaths. The most frequent sites of metastasis include liver, adrenal glands, bone, and brain. The majority of patients have advanced disease at clinical presentation. There are very few reported cases of lung cancer metastasis to stomach and duodenum. Gastric metastasis account for only 4.5% and metastasis to the small intestine account for only 5.8%. There are very few reported cases of lung cancer metastasis to stomach and duodenum. In these previously described cases, lung cancer diagnosis was already known prior to the presentation of abdominal pathology. CASE DESCRIPTION/METHODS: In this case, 59 year old female with no significant past medical history presented to the gastroenterologists’ office for abdominal pain. On laboratory examination, patient was found to have iron deficiency anemia which led to full gastroenterologic work-up. EGD was performed that showed a gastric lesion. Biopsies were taken resulting in the diagnosis of poorly differentiated carcinoma. The patient returned for biopsy and lab results, and was found to be weak and fatigued with a hemoglobin of 6. Patient was sent to the emergency room where imaging revealed a 2.4 cm endobronchial and intraparenchymal mass in the right upper lobe with distant metastases, in the left adrenal gland. There was also a 5.5 cm left cerebellar mass. An endobronchial biopsy of the right upper lobe mass, disclosed the diagnosis of non-small cell carcinoma. The gastric and lung biopsies were compared and confirmed to be similar in histology. DISCUSSION: Previously reported cases of primary lung carcinoma metastasizing to the abdomen included symptoms such as melena, dysphagia, obstructive jaundice, or perforation in patients with known diagnosis of primary lung cancer. This case is unique from prior published cases because the patient was not aware of primary lung carcinoma and the only presenting symptom was generalized abdominal pain followed by anemia. Through this case we want to emphasize the atypical presentation of metastatic lung cancer. We would also like to highlight thorough endoscopic and laboratory work up of any patient with anemia and abdominal pain. All age related screening test should be performed to exclude all differential diagnoses.

Cardiotoxicity of Immune Checkpoint Inhibitors in Patients with Lung Cancer

Background Immune checkpoint inhibitors (ICIs) activate the host immune system to target cancer cells. However, the unchecked systemic inflammatory response may result in cardiovascular immune-related adverse events, as myocarditis, pericardial disease, stress-induced, and dilated cardiomyopathy are increasingly reported in case series and pharmacovigilance databases. We sought to further investigate ICI-related cardiotoxicity in a cohort of patients with lung cancer. Methods We performed a retrospective analysis of patients with a pathologically confirmed diagnosis of primary lung cancer treated with ICIs or non-ICI systemic therapy over three years to assess the likelihood of major adverse cardiovascular events, defined as cardiovascular death, non-fatal MI, non-fatal stroke, and hospitalization for heart failure. Data was collected on co-morbidities, cardiovascular medications, past or concurrent radiation or systemic therapies, serum troponin, brain natriuretic peptide levels, pre- and post-treatment electrocardiograms, echocardiography, angiography, and total ICI dose. Each factor was compared between patients treated with ICIs and non-ICI systemic therapy. Results We included 252 patients in our study. During a median follow-up of 6 months (interquartile range: 2-14 months), patients treated with ICIs (n = 135) who had a troponin elevation were more likely to sustain a MACE (hazard ratio: 6.9, 95% confidence interval: 3.2-15, p Discussion Patients with lung cancer on ICIs are more likely to incur a troponin elevation compared to patients on conventional chemotherapy. Elevated troponin is associated with an increased likelihood of MACE, especially early during treatment with ICIs. This data supports closer monitoring, including serial troponin measurements during the early phase of ICI therapy.

Community-based lung cancer screening program: A five-year comprehensive review.

e13080 Background: Low-dose chest CT for lung cancer screening has been shown to have a significant impact on the early diagnosis of lung cancer. Initial trials have shown an approximate 20% decrease in overall lung cancer mortality (NLST, 2011). This study incorporates all patients who were evaluated by the Center for Thoracic Disease in a community-based lung cancer screening program from 2013 to 2018. Over the course of the study, thoracic surgeons have evaluated these patients with subsequent interval-based scans to monitor the progression of suspicious nodules. Methods: Eligibility criteria for the program included patients within the age range of 55-80, with a &gt; 30 pack year smoking history, and that were current smokers or quit tobacco less than 15 years ago. Individuals between 50-55 years old were also included if they had &gt; 20 pack year smoking history and at least one additional lung cancer risk factor. All patients included in this analysis completed an initial lung cancer screening consultation and recommended follow-up evaluations with thoracic surgeons from March 2013 to December 2018. All patients with suggestive abnormalities were discussed at a multidisciplinary conference prior to embarking on any invasive procedures. Patient data was collected on REDCap. Descriptive statistics for all continuous (mean ± SD) and categorical [N (%)] variables were calculated on patients. Results: 470 patients were included in the final analysis. The majority of the patients were males (56.4%), mean age was 64 years old (range: 50-81), and 55.3% were current smokers. The average smoking history was 42.3 pack years. 223 (47.6%) patients had a family history of cancer and 70 (14.5%) patients had a personal history of cancer. 25 patients (5.3%) had a diagnosis of primary lung cancer, among whom, 16 patients (64%) had early stage lung cancer (stage 1 and stage 2), 5 patients (20%) had stage 3, and 4 patients (16%) had stage 4 lung cancer. The cancer distribution included 17 adenocarcinomas (68%), 3 squamous cell carcinomas (12%), 3 small cell cancers (12%), 1 large cell cancer (4%) and 1 carcinoid tumor (4%). Conclusions: This study has demonstrated the value of enrolling patients in a community-based lung cancer screening program. Our results have reiterated the prevalence of discovering early staged lung cancer in high risk patients. This comprehensive five-year review indicates the importance of physician coordinated follow-up and evaluation in lung cancer screening patients.

Using a Dedicated Interventional Pulmonology Practice Decreases Wait Time Before Treatment Initiation for New Lung Cancer Diagnoses

While there is significant mortality and morbidity with lung cancer, early stage diagnoses carry a better prognosis. As lung cancer screening programs increase with more pulmonary nodules detected, expediting definitive treatment initiation for newly diagnosed patients is imperative. The objective of our analysis was to determine if the use of a dedicated interventional pulmonology practice decreases time delay from new diagnosis of lung cancer or metastatic disease to the chest to treatment initiation. Retrospective chart analysis was done of 87 consecutive patients with a new diagnosis of primary lung cancer or metastatic cancer to the chest from our interventional pulmonology procedures. Demographic information and time intervals from abnormal imaging to procedure and to treatment initiation were recorded. Patients were older (mean age 69) and former or current smokers (72%). A median of 27 days (1-127days) passed from our diagnostic biopsy to treatment initiation. A median of 53 total days (2-449days) passed from abnormal imaging to definitive treatment. Endobronchial ultrasound-guided transbronchial needle aspiration was the most commonly used diagnostic procedure (59%), with non-small cell lung cancer the majority diagnosis (64%). For surgical patients, all biopsy-negative lymph nodes from our procedures were cancer-free at surgical excision. Compared to prior reports from international and United States cohorts, obtaining a tissue biopsy diagnosis through a gatekeeper interventional pulmonology practice decreases median delay from abnormal imaging to treatment initiation. This finding has the potential to positively impact patient outcomes and requires further evaluation.

Characteristics of metachronous second primary lung cancers

AIM: In this study, we aimed to investigate the characteristics of metachronous second primary lung cancer (MSPLC) and the differences between primary lung cancer (PLC) and metachronous lung cancer. MATERIALS AND METHODS: Patients diagnosed with lung cancer between January 2014 and December 2016 were retrospectively studied. MSPLC tumor cases and a new diagnosis of PLC were evaluated. Clinical, radiological, and demographic findings of the two groups, previous histopathologic diagnosis of MSPLC, histopathologic diagnosis of lung cancer in both groups, stages of treatment, and treatment history were recorded. All data were analyzed using the Chi-square, t-test, Kaplan–Meier, and Log-rank method. In all tests, P RESULTS: There were 53 (16.1%) cases in MSPLC group and 277 (83.9%) cases in the PLC group. There were no statistically significant differences between clinical, radiological, and demographic findings, cancer histopathologies, tumor stages, oncological, and surgical treatment characteristics of the cases (P > 0.05). The most frequent primary cancers were laryngeal carcinoma (11 cases) in the MSPLC group, with higher age (64 and 61, P = 0.01, respectively). Tumor size was smaller (44 mm and 52 mm, respectively) than the PLC group (P = 0.03). All other characteristics of both groups (P > 0.05) and survival were similar (15 months and 17 months, P = 0.87, respectively). CONCLUSION: Among the lung cancers diagnosed in our clinic, 16% were detected as MSPLC. MSPLC group were older than the PLC group and tumor size is lower than the PLC group. There was no significant difference in treatment options and survival between the two groups.

Identifying Drivers of Multiple Readmissions After Pulmonary Lobectomy

Readmissions after pulmonary lobectomy for lung cancer are important markers of healthcare quality for surgeons and hospitals. The implications on resources and quality are magnified when examining patients who require multiple readmissions within the perioperative period. The Nationwide Readmission Database between 2013 and 2014 was investigated for patients with a primary diagnosis of lung cancer who underwent pulmonary lobectomy. Using adjusted hierarchical regression models, demographic and clinical factors during the index hospitalization were investigated for associations with single and multiple readmissions during the 90-day postoperative period. First and second readmissions during this period were compared for the primary diagnosis at the time of readmission using Clinical Classification Software codes. Of the 41,576 lobectomies during the study period 7,030 patients (16.9%) were readmitted. Among this group 1,554 patients (3.7%) had at least two readmissions. After adjustment for other factors, postoperative arrhythmia (odds ratio [OR], 1.51; 95% confidence interval [CI], 1.25-1.83; p < 0.0001), postoperative infection (OR, 1.55; 95% CI, 1.11-2.17; p= 0.01), and postoperative sepsis (OR, 1.70; 95% CI, 1.08-2.67; p= 0.02) during the index hospitalization were associated with an increased risk ofatleast two readmissions. The most frequent Clinical Classification Software diagnosis for first readmissions was "postoperative complications" (892, 12.7%) and for second readmissions was heart disease (173, 11.2%). Approximately one-fifth of patients readmitted after pulmonary lobectomy would go on to be readmitted two or more times within 90 days. Although first readmissions were most likely to present with postoperative infection or complication, second readmissions were most likely to present with heart disease.

Metachronous or synchronous primary lung cancer in the era of computed tomography surveillance

ObjectivesThe purpose of this study was to determine the frequency, characteristics, and survival of second primary lung cancer initially identified as an indeterminate lesion on the original computed tomography scan and then diagnosed during the surveillance period in a prospective study. MethodsA prospective database of 271 patients enrolled in a surveillance study was updated. Indeterminate lesions present on the original computed tomography at the time of initial primary lung cancer diagnosis that subsequently grew and were diagnosed as cancer were termed “synchronous primary lung cancer.” Lesions that were not present on the original computed tomography scan and subsequently diagnosed on surveillance were termed “metachronous primary lung cancer.” ResultsThirty patients (11.1%) developed 37 second primary lung cancers over a median surveillance period of 84.7 (range, 15.9-147.6) months. Of these, 15 of 37 (40.5%) were identified as synchronous primary lung cancer, and 22 of 37 (59.5%) were identified as metachronous primary lung cancer. At first identification, ground-glass lesions were identified in 9 of 15 (60%) synchronous primary lung cancers compared with only 5 of 22 (22.7%) of metachronous primary lung cancers (P = .034). Compared with metachronous primary lung cancer, from first identification to diagnosis, synchronous primary lung cancer developed over a longer interval (33.6 vs 7.2 months, P = .001) and had a slower growth rate (0.17 vs 0.45 mm/month, P = .027). The 5-year overall survival from second lung cancer was 73.0%. No significant differences were observed between the synchronous primary lung cancer and metachronous primary lung cancer cohorts in overall survival from initial primary lung cancer (P = .583) or from second lung cancer (P = .966). ConclusionsComputed tomography surveillance identifies 2 types of curable second lung cancers leading to excellent overall survival.

Exhaled gas detection by Ir-doped CNT for primary diagnosis of lung cancer

Given the serious threat of lung cancer due to the strong concealment at early stage, primary diagnosis becomes quite essential to guarantee human health. The adsorption behaviors of introduced Ir-CNT upon two categories of typical gases of lung cancer (aniline and o-toluidine) have been investigated based on DFT method. At the same time, the sensing characteristics towards these two gases were conducted as well by our prepared sensors prepared by drying the Ir deposited CNT aqueous solution onto the interdigital electrode substrate. Results indicate that Ir-CNT based material can be desirable and promising for sensing upon exhaled gas of lung cancer patient, because of the excellent adsorptions upon two kinds of main typical gases. Such strong interactions of Ir-CNT towards typical gas adsorbed leads to the significant electronic redistributions of the modified surface, thereby causing apparent reduction in conductivity after adsorptions. This could be detected by a practical prepared resistivity-type sensor. Our theoretical calculations are in good accordance with the experimental results, which demonstrate the feasibility of Ir-CNT for potential application in the near future in the field of lung cancer diagnosis.

SPEAR: STUDY OF PATIENTS WITH PARA-PNEUMONIC PLEURAL EFFUSION WHO ARE RE-ADMITTED WITHIN 30 DAYS

SESSION TITLE: Disorders of the Pleura SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 pm - 02:00 pm PURPOSE: Parapneumonic pleural effusions (PPE) pose a significant risk of morbidity and mortality in patients admitted with pneumonia. There are limited data on readmissions in such patients. Readmission rate is an important healthcare quality metric. We sought to determine the rate of 30-day readmissions following an index admission for PPE and the major causes and in-hospital mortality in such cases. METHODS: This is a retrospective cohort study using the 2014 National Readmission Database (NRD). Adults admitted with a primary diagnosis of pneumonia complicated by pleural effusion were included. Patients with primary diagnosis of lung cancer and heart failure, those who died during index admission and inter-hospital transfers were excluded. ICD 9 codes were used to identify all diagnoses. RESULTS: A total of 10,167 index admissions were identified with primary diagnosis of PPE between January to November of 2014. After excluding 364 patients (3.6%) who died during the index admission, 9803 patients were included in the readmission analysis. Of these, 1,313 (13.4%) were re-admitted within 30 days. The average age of these patients was 68.4 years and half were women. The most common causes of readmission were pneumonia (15.5%) and pleural effusion including empyema (13%). Other causes included sepsis (9.7%), heart failure (7.1%) and respiratory failure (3.9%). The in-hospital mortality was 9%, which is higher compared to the index admission (3.6%). CONCLUSIONS: There is a major risk of 30-day readmissions in patients admitted with PPE. Major causes of readmissions were respiratory including pneumonia and pleural effusion. CLINICAL IMPLICATIONS: There is a need to identify predictors of early re-admission in patients with PPE. DISCLOSURES: No relevant relationships by Karishma Bhatia, source=Web Response No relevant relationships by Sathish Pondaiah, source=Web Response No relevant relationships by Naveen Premnath, source=Web Response No relevant relationships by Adil Shujaat, source=Web Response No relevant relationships by Karan Sud, source=Web Response

Help-seeking behaviour in newly diagnosed lung cancer patients: Assessing the role of perceived stigma.

ObjectiveThis study explored help‐seeking behaviours, group identification, and perceived legitimacy of discrimination, and its potential relationship with perceived lung cancer stigma.MethodsConsecutive consenting adults (n = 274) with a primary diagnosis of lung cancer within the previous 4 months were recruited at 31 outpatient clinics in Australia. A self‐report survey assessed help‐seeking, group identification, perceived legitimacy of discrimination, and perceived lung cancer stigma.ResultsServices providing assistance from health professionals (69.5%) and informational support (68.5%) were more frequently used than emotional‐based support. Only a small proportion (2.6%) of participants were unlikely to seek help from anyone, with the most popular sources of help being the general practitioner (91.0%), and oncologist/treating clinician (81.3%). One‐fifth (21.1%) indicated they identified with being a lung cancer patient, and most did not perceive discrimination against lung cancer patients. Higher perceived lung cancer stigma was significantly associated with greater perceived legitimacy of discrimination (P < 0.001), but not help‐seeking behaviours or group identification.ConclusionsThe relationship between lung cancer stigma and perceived legitimacy of discrimination may guide initiatives to reduce stigma for patients. It is encouraging that perceived stigma did not appear to inhibit help‐seeking behaviours. However, further research in this emerging field is needed to investigate patterns of perceived stigma and help‐seeking over time to identify how and when to offer support services most appropriate to the needs of lung cancer patients.