The case-based interactive discussion session, Challenges in Lung Cancer Diagnosis and Staging, will review lung cancer diagnosis and staging guidelines in the context of specific clinical scenarios. These include the solitary pulmonary nodule, centrally located tumor, advanced lung cancer, and synchronous primary tumors, said Anne V. Gonzalez, MD, FCCP. The Sunday session starts at 7:30 am in the convention center, room 212A.
The goals of the session include:
- Outline an evidence-based approach to lung cancer diagnosis and staging.
- Discuss the role, yield, and limitations of noninvasive and invasive modalities used in the diagnosis and staging of lung cancer.
- Recognize the challenges of specific scenarios of lung cancer investigation.
“Accurate staging is essential, as stage directly impacts patient management and prognosis,” said Dr. Gonzalez, chair of the session and a researcher at McGill University Health Centre. “The dividing line established when staging nonsmall cell lung cancer (NSCLC) is between patients who are candidates for surgical resection (stages I and II, and selected patients with stage III disease), and those who are inoperable but will benefit from chemotherapy, radiotherapy, or both (stages III and IV). The five-year survival of patients varies significantly according to disease stage at presentation. The importance of accurate staging thus seems intuitive, given the pivotal effect of stage on treatment choice and prognosis. Yet evidence points to significant quality gaps in lung cancer diagnosis and staging.”
ACCP guidelines for the staging of NSCLC were last updated in 2013. Complete staging requires both imaging studies (CT chest, PET scan +/- brain imaging) and invasive diagnostic procedures to achieve the necessary tissue confirmation, Dr. Gonzalez explained. Invasive testing can frequently provide simultaneous confirmation of tissue diagnosis and disease stage.
“This approach is favored as it leads to a more efficient investigation process,” she added. “However, applying this principle requires a good understanding of which imaging findings require tissue confirmation, and may be facilitated by a multidisciplinary team discussion.”
Quality indicators for the evaluation of patients with lung cancer were recently recommended by the ACCP. There is a need for dissemination of lung cancer guidelines, and their application to specific clinical scenarios.
Some of the challenges to lung cancer investigation, and specific questions to be tackled during the session include:
- Which patients with solitary pulmonary nodules should undergo invasive mediastinal staging?
- Which patients with solitary pulmonary nodules should undergo brain imaging?
- What is the definition of a centrally located tumor, and what are the implications for invasive staging?
- With regards to invasive mediastinal staging, when should a negative needle technique be followed by surgical staging?
- How can lung cancer diagnosis and staging be pursued concomitantly, to minimize the number of invasive diagnostic procedures, and their attendant complications?
- How can we ensure that sufficient tissue will be available to allow both histological characterization and molecular testing, in patients with advanced lung cancer?
Finally, the evaluation of the patient with more than one primary lung cancer is complex, and best performed by a multidisciplinary team. Dr. Gonzalez said the recently proposed classification of patients with multiple pulmonary sites of lung cancer also will be reviewed during the session.
Use of the Audience Response System (ARS) will be a central feature of this case-based interactive discussion. Audience response questions help trigger reflection and sustain participants’ attention, while allowing real-time needs assessment by the presenters, based on the responses provided.