PS01.16: Shortening Time from Diagnosis to Treatment in NSCLC: Are Blood-Based Biopsies the Answer?

Abstract

ules >6mm) with the potential need to pursue diagnostic sampling were reviewed in a multidisciplinary fashion. Basic demographics and procedural outcomes after the decision to biopsy were obtained. Results: A total of 516 patients were enrolled within the lung cancer screening program from 2013 e 2016. Nodule(s) >6mm were identified in 164 (31.8%) patients. Subsequently, 25 (4.8%) patients underwent some form of invasive testing. The mean age of this population was 66.2 (SD-6.7) years with 56% (14/25) being female and mean pack years of 50.8 (SD-19.5). Percutaneous needle aspiration (n¼11), endoscopic sampling (n¼10), and surgical biopsy/resection (n¼4) were performed as the first invasive diagnostic procedure. The outcomes of this initial sampling were cancer (n¼15), non-diagnostic (n¼7), benign (n¼2), and infection (n¼1). Three patients without an initial diagnosis underwent additional non-surgical biopsy attempts. Overall, surgical resection was performed in twelve patients (6 after previous diagnostic procedure, 2 after previous non-diagnostic procedure, and 4 as initial procedure). Final outcomes were cancer (n¼16), nondiagnostic procedure (n¼4), non-caseating granulomatous inflammation (n¼2), benign diagnosis after wedge resection (n¼2), and infection (n¼1). Conclusion: Within a nurse practitioner led, multidisciplinary, lung cancer screening program, a small proportion of patients undergo invasive diagnostic testing, despite a rather high prevalence of potentially actionable nodules. Within the NLST population receiving computed tomography, 6.1% underwent invasive testing with 43% undergoing testing that ultimately did not result in a cancer diagnosis. Within our multidisciplinary program, 4.8% underwent invasive testing with 36% undergoing testing not ultimately resulting in a cancer diagnosis. The utilization of multidisciplinary teams during the biopsy decision-making process may help decrease the number of non-diagnostic procedures. Further research is needed to help identify tools that improve patient selection for invasive testing in lung cancer screening programs.

Tumor heterogeneity: does it matter?

“…While the mechanism of ctDNA release from tumour cells has not been fully elucidated, most studies suggest apoptosis or necrosis of tumour cells as its main source [49]. These methods yield results more quickly than standard biopsies [50] and could potentially alleviate the challenges of spatial heterogeneity [51]. Given its short half-life, ctDNA may also be more reflective of the real-time tumour genome than other sources [52,53].…”