1. 1. CLASSIFICATION AND STAGING OF LUNG CANCER
2. 2. INDEX Relevance WHO classification of tumours of the lung TNM Lung carcinoma stages Positron Emission Tomography (PET) EBUS-TBNA / EUS-FNA Novel approaches in lung cancer diagnostic, staging and treatment Conclusions
3. 3. Relevance Most common cause of cancer death Second most common cancer in men and women 1,59 million deaths in 2012 158,040 deaths estimated in 2015 in USA More individuals die from lung cancer than from colorectal, breast and prostate cancer combined
4. 4. Relevance
5. 5. WHO classification of tumours of the lung International Agency for Research on Cancer 4th Edition
6. 6. Epithelial tumours Adenocarcinoma Squamous cell carcinoma Small cell carcinoma Large cell carcinoma Adenosquamous carcinoma Sarcomatoid carcinoma Carcinoid tumour Salivary gland tumours Papillomas Adenomas Adenocarcinoma Squamous cell carcinoma Neuroendocrine tumours Large cell carcinoma Adenosquamous carcinoma Pleomprphic carcinoma Spindle cell carcinoma Giant cell carcinoma Carcinosarcoma Pulmonary blastoma Other and unclassified carcinoma Salivary gland-type tumours Papillomas Adenomas 2004 2015 International Agency for Research on Cancer 4th Edition
7. 7. Adenocarcinoma Mixed subtype Acinar Papillary Bronchioloalveolar Solid Lepidic Acinar Papillary Micropapillary Solid Invasive Colloid Fetal Enteric Minimally invasive - MIA Non-mucinous Mucinous Preinvasive lesions Atypical adenomatous hyperplasia Adenocarcinoma in situ Non mucinous Mucinous 2004 2015 International Agency for Research on Cancer 4th Edition
8. 8. TNM Detterbeck et al. CHEST 2013; 143(5)(Suppl):e191Se210S
9. 9. Stage groups and subgroups according to TNM Detterbeck et al. CHEST 2013; 143(5)(Suppl):e191Se210S
10. 10. Lung carcinoma stages (I and II) Detterbeck et al. CHEST 2013; 143(5)(Suppl):e191Se210S
11. 11. Lung carcinoma stages (III) Detterbeck et al. CHEST 2013; 143(5)(Suppl):e191Se210S
12. 12. Lung carcinoma stages (IV) Detterbeck et al. CHEST 2013; 143(5)(Suppl):e191Se210S
13. 13. IASLC lymph node map Detterbeck et al. CHEST 2013; 143(5)(Suppl):e191Se210S
14. 14. J Thorac Oncol. 2014;9: 16181624
15. 15. J Pathol 2014; 232: 121133 PD-1-pathway blockers Immuno-regulatory antibodies for the treatment of cancer. Honeychurch et al. Expert Opin Biol Ther. 2015 Jun;15(6):787-801.
16. 16. Diagnosing and Staging Lung Cancer Involving the Mediastinum Murgu et al. CHEST 2015; 147(5): 1401 - 1412
17. 17. Positron Emission Tomography (PET) - Staging: T N M - Restaging - Treatment efficacy assessment - Radiotherapy planning
18. 18. Positron Emission Tomography (PET) Andrea Gallamini et Al. Cancers 2014, 6, 1821-1889 - Changes the management in 20-30% of patients with NSCLC - T staging: accurate in up to 86% of patients - N staging: metabolic info, but sensitivity 45% - M staging: unsuspected distant M in 28% of patients. Impact on treatment in 53% - Limitations: low sensitivity for cerebral imaging and high rate of false positive results (infections, sarcoidosis etc.)
19. 19. Positron Emission Tomography (PET) Andrea Gallamini et Al. Cancers 2014, 6, 1821-1889
20. 20. EBUS-TBNA / EUS-FNA Murgu et al. CHEST 2015; 147(5): 1401 - 1412
21. 21. EBUS-TBNA / EUS-FNA Murgu et al. CHEST 2015; 147(5): 1401 - 1412
22. 22. NOVEL APPROACHES IN LUNG CANCER DIAGNOSTIC AND STAGING
23. 23. Andreo et al. Arch Bronconeumol. 2015;51:e8e11.
24. 24. Izumo et al. Jpn J Clin Oncol 2014;44(10)
25. 25. Fiz et al. BMC Medical Imaging 2014, 14:22
26. 26. Thorax 2011;66:1072e1077.
27. 27. AJRCCM Articles in Press. June-2015 as 10.1164/rccm.201502-0205OC
28. 28. Herth FJF, et al. Thorax 2015;70:326332.
29. 29. Eur Respir J 2013; 41: 14011408
30. 30. NEJM, DOI: 10.1056/NEJMoa1504601 - AEGIS-1 and AEGIS-2 - Independent, prospective, multicenter, observational studies - Classifier + Bronchoscopy - sensitivity of 96% in AEGIS1 and 98% in AEGIS2
31. 31. J Thorac Oncol. 2015;10: 237249 Dual-energy CT - Diffusion-weighted MRI - Sodium (23Na) MRI - 3-deoxy-3-[18F]-fluorothymidine PET - Others Dynamic contrast-enhanced CT
32. 32. Mehta et al. CHEST 2014; 145(3):464472 Artificial Intelligence in Medicine 60 (2014) 165177
33. 33. Omlor et al. Respiratory Research (2015) 16:64 Eur Respir J 2012; 40: 448454 Nanotechnology in respiratory medicine A breath test for malignant mesothelioma using an electronic nose
34. 34. Conclusions Tobacco prevention remains the cornerstone in the battle against lung cancer Lung Cancer is a complex disease and multidisciplinary approach is needed in order to obtain best results Continuous modification and upgrading of the lung cancer classification American Journal of Respiratory and Critical Care Medicine, Vol. 191, No. 12 (2015), pp. 1471.
35. 35. Conclusions Importance of international meetings and consensuses in order to achieve maximum level of standardization Implementation of new technologies for enhancing diagnostic, staging and treatment of lung cancer A field of great advances, and more exciting results to come in future years
36. 36. Thanks a lot!