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CHICAGO - A novel technique utilizing stapled lung debris could help determine adequate and inadequate surgical margins in resected non-small cell lung cancer, results of a prospective study suggest.
Researchers at Albany (N.Y.) Medical College and the Hospital of St. Raphael in New Haven, Conn., are using cytology to analyze lung tissue taken from spent staple cartridges used during sublobar resection. The staple cartridge is simply mixed with 30 cc of normal saline and serves as the cytologic margin, Dr. Thomas Fabian explained at the Chicago Multidisciplinary Symposium in Thoracic Oncology.
"People have [observed] that certain staples used through cancers can potentially contaminate new tissue planes, so that is how the idea was born," he said in an interview.
Dr. Fabian and his colleagues prospectively compared staple-line cytology with traditional histopathologic evaluation of surgical specimens taken from 97 patients undergoing diagnostic sublobar wedge resection between November 2007 and September 2009. Of the 98 specimens retrieved, 30 were benign and 68 were malignant.
Staple-line cytology was 100% accurate in the evaluation of benign lesions when compared with histology, he said.
In the 68 malignant nodules, initial blinded cytologic evaluation was positive in 7, surgical pathology was positive in 6, and both were positive in 4.
Subsequent unblinded review of both specimens changed the final pathologic interpretation in 4 (6%) of the 68 cases, said Dr. Fabian, chief of thoracic surgery at the Albany Medical Center. The interpretation changed from a negative margin to a positive margin in 3 surgical specimens (7%) and in 1 staple-line cytology specimen (2%).
According to analysis of the unblinded data, staple-line cytology demonstrated an overall accuracy of 96%, with 88% sensitivity, 97% specificity, 70% positive-predictive value, and 99% negative-predictive value.
Dr. Fabian described staple-line cytology as a simple technique that could serve as an adjunct to the gold standard of histopathology, which he said is prone to inaccuracies including both false positives and false negatives.
"We need to reevaluate the techniques that allow us to accurately assess surgical margins - particularly in the setting of sublobar resections, given the growing interest in this technique," according to Dr. Fabian.
"The cytologic technique appears to be sensitive, specific, and accurate, but it does need to be validated at other institutions and with additional studies," he added.
Dr. Fabian acknowledged that by design the study lacked clinical outcome data and said further evaluation is ongoing. The next step is to evaluate the technique in patients undergoing sublobar resection with curative intent.
Of the 68 malignant samples, 43 were diagnosed as adenocarcinoma, 7 as squamous cell carcinoma, 3 as large cell, 1 as small cell, 5 as carcinoid, and 9 as other histologies.
Dr. Fabian disclosed serving as a speaker for, and receiving research funding and honoraria from, Covidien. His coauthors reported no conflicts.
CHICAGO - A novel technique utilizing stapled lung debris could help determine adequate and inadequate surgical margins in resected non-small cell lung cancer, results of a prospective study suggest.
Researchers at Albany (N.Y.) Medical College and the Hospital of St. Raphael in New Haven, Conn., are using cytology to analyze lung tissue taken from spent staple cartridges used during sublobar resection. The staple cartridge is simply mixed with 30 cc of normal saline and serves as the cytologic margin, Dr. Thomas Fabian explained at the Chicago Multidisciplinary Symposium in Thoracic Oncology.
"People have [observed] that certain staples used through cancers can potentially contaminate new tissue planes, so that is how the idea was born," he said in an interview.
Dr. Fabian and his colleagues prospectively compared staple-line cytology with traditional histopathologic evaluation of surgical specimens taken from 97 patients undergoing diagnostic sublobar wedge resection between November 2007 and September 2009. Of the 98 specimens retrieved, 30 were benign and 68 were malignant.
Staple-line cytology was 100% accurate in the evaluation of benign lesions when compared with histology, he said.
In the 68 malignant nodules, initial blinded cytologic evaluation was positive in 7, surgical pathology was positive in 6, and both were positive in 4.
Subsequent unblinded review of both specimens changed the final pathologic interpretation in 4 (6%) of the 68 cases, said Dr. Fabian, chief of thoracic surgery at the Albany Medical Center. The interpretation changed from a negative margin to a positive margin in 3 surgical specimens (7%) and in 1 staple-line cytology specimen (2%).
According to analysis of the unblinded data, staple-line cytology demonstrated an overall accuracy of 96%, with 88% sensitivity, 97% specificity, 70% positive-predictive value, and 99% negative-predictive value.
Dr. Fabian described staple-line cytology as a simple technique that could serve as an adjunct to the gold standard of histopathology, which he said is prone to inaccuracies including both false positives and false negatives.
"We need to reevaluate the techniques that allow us to accurately assess surgical margins - particularly in the setting of sublobar resections, given the growing interest in this technique," according to Dr. Fabian.
"The cytologic technique appears to be sensitive, specific, and accurate, but it does need to be validated at other institutions and with additional studies," he added.
Dr. Fabian acknowledged that by design the study lacked clinical outcome data and said further evaluation is ongoing. The next step is to evaluate the technique in patients undergoing sublobar resection with curative intent.
Of the 68 malignant samples, 43 were diagnosed as adenocarcinoma, 7 as squamous cell carcinoma, 3 as large cell, 1 as small cell, 5 as carcinoid, and 9 as other histologies.
Dr. Fabian disclosed serving as a speaker for, and receiving research funding and honoraria from, Covidien. His coauthors reported no conflicts.
CHICAGO - A novel technique utilizing stapled lung debris could help determine adequate and inadequate surgical margins in resected non-small cell lung cancer, results of a prospective study suggest.
Researchers at Albany (N.Y.) Medical College and the Hospital of St. Raphael in New Haven, Conn., are using cytology to analyze lung tissue taken from spent staple cartridges used during sublobar resection. The staple cartridge is simply mixed with 30 cc of normal saline and serves as the cytologic margin, Dr. Thomas Fabian explained at the Chicago Multidisciplinary Symposium in Thoracic Oncology.
"People have [observed] that certain staples used through cancers can potentially contaminate new tissue planes, so that is how the idea was born," he said in an interview.
Dr. Fabian and his colleagues prospectively compared staple-line cytology with traditional histopathologic evaluation of surgical specimens taken from 97 patients undergoing diagnostic sublobar wedge resection between November 2007 and September 2009. Of the 98 specimens retrieved, 30 were benign and 68 were malignant.
Staple-line cytology was 100% accurate in the evaluation of benign lesions when compared with histology, he said.
In the 68 malignant nodules, initial blinded cytologic evaluation was positive in 7, surgical pathology was positive in 6, and both were positive in 4.
Subsequent unblinded review of both specimens changed the final pathologic interpretation in 4 (6%) of the 68 cases, said Dr. Fabian, chief of thoracic surgery at the Albany Medical Center. The interpretation changed from a negative margin to a positive margin in 3 surgical specimens (7%) and in 1 staple-line cytology specimen (2%).
According to analysis of the unblinded data, staple-line cytology demonstrated an overall accuracy of 96%, with 88% sensitivity, 97% specificity, 70% positive-predictive value, and 99% negative-predictive value.
Dr. Fabian described staple-line cytology as a simple technique that could serve as an adjunct to the gold standard of histopathology, which he said is prone to inaccuracies including both false positives and false negatives.
"We need to reevaluate the techniques that allow us to accurately assess surgical margins - particularly in the setting of sublobar resections, given the growing interest in this technique," according to Dr. Fabian.
"The cytologic technique appears to be sensitive, specific, and accurate, but it does need to be validated at other institutions and with additional studies," he added.
Dr. Fabian acknowledged that by design the study lacked clinical outcome data and said further evaluation is ongoing. The next step is to evaluate the technique in patients undergoing sublobar resection with curative intent.
Of the 68 malignant samples, 43 were diagnosed as adenocarcinoma, 7 as squamous cell carcinoma, 3 as large cell, 1 as small cell, 5 as carcinoid, and 9 as other histologies.
Dr. Fabian disclosed serving as a speaker for, and receiving research funding and honoraria from, Covidien. His coauthors reported no conflicts.