Home
|
Inbox
|
Search
|
View Abstract
Role of PET-CT in the Diagnosis and Staging of Suspected Lung Cancer Limited to the Chest: The Importance of Following the Guidelines
Description
.abstract img { width:300px !important; height:auto; display:block; text-align:center; margin-top:10px } .abstract { overflow-x:scroll } .abstract table { width:100%; display:block; border:hidden; border-collapse: collapse; margin-top:10px } .abstract td, th { border-top: 1px solid #ddd; padding: 4px 8px; } .abstract tbody tr:nth-child(even) td { background-color: #efefef; } .abstract a { overflow-wrap: break-word; word-wrap: break-word; }
A4420 - Role of PET-CT in the Diagnosis and Staging of Suspected Lung Cancer Limited to the Chest: The Importance of Following the Guidelines
Author Block: C. A. Aravena Leon1, Y. Sarda2, J. C. Cicenia3, T. R. Gildea3, M. Machuzak3, S. Sethi3, A. C. Mehta3, M. L. Ribeiro Neto3, H. Choi3, B. P. Young4, P. J. Mazzone3, L. S. Lam3, F. A. Almeida3; 1Enfermedades Respiratorias del Adulto, Universidad Catolica de Chile, Santiago, Chile, 2Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, United States, 3Respiratory Institute, Cleveland Clinic, Cleveland, OH, United States, 4Pulmonary, Critical Care, and Sleep Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United States.
INTRODUCTION: The diagnosis and staging of suspected lung cancer is a unified process. The evaluating clinician should aim to perform the least number of invasive procedures to determine the highest stage while providing enough tissue to perform the necessary testing in the era of targeted therapy. The initial clinical and CT imaging evaluation may suggest the likely disease stage. However, PET-CT has been shown to detect more metastasis than CT alone. Both the American College of Chest Physicians and the National Comprehensive Cancer Network recommend obtaining a PET-CT before invasive testing for patients with a high suspicion for (non-small cell) lung cancer. Yet, insurance companies often decline covering this test before a cancer diagnosis. This may be due to the lack of studies evaluating the utility of PET-CT in patients with a high suspicion for lung cancer before a diagnosis has been established.
METHODS: Records from the Cleveland Clinic ongoing bronchoscopy registry were reviewed. Patients undergoing bronchoscopy for EBUS staging and diagnosis of suspected lung cancer between January 2016 and June 2017 were included. Additional inclusion criteria: ≥ 20-pack-year smoking history and presence of lung mass (>3 cm) or nodule (2-3 cm) and associated intrathoracic lymphadenopathy. Exclusion criteria: active or prior intrathoracic cancer, active or prior extra-thoracic cancer within past five years (non-melanoma skin cancers not excluded), clinical suspicion of M1 disease based on imaging at time of EBUS and/or prior invasive testing for the suspected lung cancer.
RESULTS: 178 patients met the criteria above. PET-CT was available before the EBUS in 71 (39.9%). In this group, 69 (97.2%) were ultimately diagnosed with lung cancer and 2 (2.8%) with an infection. Among the 107 in which PET was not available at the time of EBUS, 102 (95.3%) turned out to have a malignant diagnosis (p=0.532744). Stage 4 disease was identified in 2 (2.9%) patients when PET-CT was available before EBUS versus 14 (14.1%) when PET-CT had not been done (p=0.014596). It suggested stage 4 disease in 12 of the 14 individuals on the latter group versus none in the former (p=0.001578). Futile EBUS staging was performed in 24 (13.5%) cases of the entire population versus 7 (3.9%) futile PET-CTs (p=0.001395).
CONCLUSIONS: This is the first study demonstrating the importance of guidelines-consistent care to obtain PET-CT before the performance of any invasive testing in patients with suspected lung cancer limited to the chest but at high risk for metastatic disease.
Author Block: C. A. Aravena Leon1, Y. Sarda2, J. C. Cicenia3, T. R. Gildea3, M. Machuzak3, S. Sethi3, A. C. Mehta3, M. L. Ribeiro Neto3, H. Choi3, B. P. Young4, P. J. Mazzone3, L. S. Lam3, F. A. Almeida3; 1Enfermedades Respiratorias del Adulto, Universidad Catolica de Chile, Santiago, Chile, 2Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, United States, 3Respiratory Institute, Cleveland Clinic, Cleveland, OH, United States, 4Pulmonary, Critical Care, and Sleep Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United States.
INTRODUCTION: The diagnosis and staging of suspected lung cancer is a unified process. The evaluating clinician should aim to perform the least number of invasive procedures to determine the highest stage while providing enough tissue to perform the necessary testing in the era of targeted therapy. The initial clinical and CT imaging evaluation may suggest the likely disease stage. However, PET-CT has been shown to detect more metastasis than CT alone. Both the American College of Chest Physicians and the National Comprehensive Cancer Network recommend obtaining a PET-CT before invasive testing for patients with a high suspicion for (non-small cell) lung cancer. Yet, insurance companies often decline covering this test before a cancer diagnosis. This may be due to the lack of studies evaluating the utility of PET-CT in patients with a high suspicion for lung cancer before a diagnosis has been established.
METHODS: Records from the Cleveland Clinic ongoing bronchoscopy registry were reviewed. Patients undergoing bronchoscopy for EBUS staging and diagnosis of suspected lung cancer between January 2016 and June 2017 were included. Additional inclusion criteria: ≥ 20-pack-year smoking history and presence of lung mass (>3 cm) or nodule (2-3 cm) and associated intrathoracic lymphadenopathy. Exclusion criteria: active or prior intrathoracic cancer, active or prior extra-thoracic cancer within past five years (non-melanoma skin cancers not excluded), clinical suspicion of M1 disease based on imaging at time of EBUS and/or prior invasive testing for the suspected lung cancer.
RESULTS: 178 patients met the criteria above. PET-CT was available before the EBUS in 71 (39.9%). In this group, 69 (97.2%) were ultimately diagnosed with lung cancer and 2 (2.8%) with an infection. Among the 107 in which PET was not available at the time of EBUS, 102 (95.3%) turned out to have a malignant diagnosis (p=0.532744). Stage 4 disease was identified in 2 (2.9%) patients when PET-CT was available before EBUS versus 14 (14.1%) when PET-CT had not been done (p=0.014596). It suggested stage 4 disease in 12 of the 14 individuals on the latter group versus none in the former (p=0.001578). Futile EBUS staging was performed in 24 (13.5%) cases of the entire population versus 7 (3.9%) futile PET-CTs (p=0.001395).
CONCLUSIONS: This is the first study demonstrating the importance of guidelines-consistent care to obtain PET-CT before the performance of any invasive testing in patients with suspected lung cancer limited to the chest but at high risk for metastatic disease.
|
Home
|
Inbox
|
Search
|