This study showed not only that histologic subtype and mitotic rate are important prognostic factors in lung ADCs, but also that other criteria described previously may not be useful in our specific patient population.

MINS is common after general thoracic surgery. Early cardiology intervention reduced the expected hazard ratio of early death from 3.87 to an odds ratio of 1.69 with no significant difference in 30-day mortality for patients who developed MINS.

Positron emission tomography-CT (PET-CT) is one of the initial mediastinal staging modality for non-small cell lung cancer; however, the clinical utility in carcinoid tumours is uncertain. We sought to determine the test performance of PET-CT for mediastinal lymph node staging of pulmonary carcinoid tumours. We collated data from seven institutions, performing a retrospective search on pathological databases for a consecutive series of patients who underwent thoracic surgery (with lymph nodal dissection) for carcinoid tumours with preoperative PET-CT staging. PET-CT results were compared with the reference standard of pathologic results obtained from lymph node dissection and test performance reported using sensitivity and specificity. From November 1999 to January 2013, 247 patients from seven institutions underwent surgery for carcinoid tumours with a corresponding preoperative PET-CT scan. The mean age of the patients was 61 (SD 15, range 73) and 84 were male patients (34%). The pathologic subtype was typical carcinoid in 217 patients (88%) and atypical carcinoid in 30 patients (12%). Results from lymph node dissection were obtained in 207 patients. The calculated sensitivity and specificity of PET-CT to identify mediastinal lymph node disease was 33% (95% CI 4% to 78%) and 94% (95% CI 89% to 97%), respectively. Our results indicate that PET-CT has a poor sensitivity but good specificity to detect the presence of mediastinal lymph node metastases in pulmonary carcinoid tumours. Mediastinal lymph node metastases cannot be ruled out with negative PET-CT uptake, and if the absence of mediastinal lymph node disease is a prerequisite for directing management, tissue sampling should be undertaken.

Myocardial injury after non-cardiac surgery (MINS) has been recently defined as troponin elevation ≥0.03ng/ml, associated with 3.87 fold increase in early mortality (1). We sought to determine the impact of early cardiology intervention on 30-day mortality in patients who underwent general thoracic surgery and developed MINS. Methods: A retrospective review of patients who underwent thoracic surgery over a 5-year period where troponin levels were routinely measured on the first post-operative day was performed. Data acquisition and mortality status was obtained via medical records and NHS tracing systems. Thirty-day mortality was compared on the MINS cohort using Fisher’s exact square testing and logistic regression analysis. Actuarial survival was calculated using Kaplan Meier method and Cox proportional hazards regression was utilized to determine risk adjusted impact of MINS on post-operative survival. Results: Troponin levels were measured in 492 (96%) of 511 patients and 80 (16%) had troponin elevation fulfilling MINS criteria. Of the MINS positive patients, 61 (76%) received early cardiology consult and a formal diagnosis of “myocardial infarction” stated in 4 (5%). Risk assessment for Acute Myocardial Infarction was performed in all patients and 20 (25%) commenced on anti-platelet agents, 4 (5%) on β-blockers and 1 (1%) underwent primary coronary intervention. In total, 49 (61%) received primary risk factor modification and 26 (33%) had further cardiology outpatient follow-up. There were no significant differences in the proportion who died within the first 30 days in the MINS group (2.6%) compared to the non-MINS group (1.6%; P=0.625). The odds ratio for 30-day mortality in the MINS group was 1.69 (95% CI 0.34 to 8.57, P=0.522). On follow up there were no significant difference on the impact of MINS on survival between the two groups (HR 1.06 95% CI 0.67 to 1.68; P=0.799). Conclusion: Our results confirm MINS is common after general thoracic surgery. We observed that early cardiology intervention reduced the expected hazard ratio of early death from 3.87 to an odds ratio of 1.69 with no significant difference in either early or longer term mortality for patients who developed MINS.

7544 Background: PET-CT is a standard investigation to stage the mediastinum in non-small cell lung cancer when radical management is planned. The clinical utility of PET-CT in carcinoid tumours is uncertain as its test performance at identifying mediastinal lymph node disease in these tumours is as yet undefined with such tumours being rare and FDG avidity often variable or low. We sought to determine the test performance of PET-CT for mediastinal lymph node staging of pulmonary carcinoid tumours. Methods: We collated retrospective data from 5 institutions for a consecutive series of patients who underwent thoracic surgery for carcinoid tumours and had preoperative PET-CT staging prior to surgery (with lymph nodal dissection). PET-CT results were compared against the reference standard of pathologic results obtained from lymph node dissection, and test performance reported using sensitivity and specificity. Results: From November 1999 to May 2012, a total of 153 patients with a preoperative PET-CT scan from 5 institutions underwent surgery for a carcinoid tumour. The mean age of the patients was 60 (SD 16) and 67 were male (44%). The pathologic sub-type was typical carcinoid in 138 patients (90%) and atypical carcinoid in 15 patients (10%). The mean SUV uptake in the primary tumour was 4.9 (SD 5). Results from lymph node dissection were obtained in 125 patients and the sensitivity and specificity of PET-CT to identify mediastinal lymph node disease was 40% (95% CI 5-85%) and 93% (93-99%) respectively. Conclusions: In this largest cohort study to date, our results suggest that PET-CT has a poor sensitivity but good specificity for mediastinal lymph node metastases for pulmonary carcinoid tumours. Therefore lymph node metastases cannot accurately be ruled out in carcinoid tumours with a negative PET-CT. If treatment decisions are based on the N2 status, invasive mediastinal staging should be undertaken in carcinoid tumours.