P3.04-006 The Effect of Preoperative Multi-Disciplinary Support Commenced at Outpatient Clinic on Lung Cancer Patients

Abstract

Background: Computed tomography (CT) can reveal small pulmonary nodules of 2 cm. Nodules with a consolidation-to-tumor ratio (C/T ratio) 0.5 on thinsection chest CT are generally recognized as noninvasive lung cancer. However, estimations of C/T ratios on CT may vary between observers. Three-dimensional (3D) imaging can provide more accurate information than 2D-CT for distinguishing noninvasive lung cancers. The aims of this study were to determine the 3D-C/T ratios of small pulmonary nodules on 3D-CT images and explore the relationship between 3D-C/T ratios and the histopathological invasiveness of lung cancers. Methods: This was a retrospective analysis of a total of 82 patients with lung adenocarcinoma who had a ground glass opacity (GGO) on CT and underwent surgery from April 2013 to March 2016. We constructed 3D tumor images and calculated the 3D-C/T ratios of GGOs using a 3D analysis system (SYNAPSE VINCENT ® ; Fuji Film). The relationships between 3D-C/T ratio and histopathological indicators of invasiveness were evaluated. Pathological noninvasive cancer was defined as follows: no lymph node metastasis (n[-]), no lymphatic invasion (ly[-]), no vascular invasion (v[-]), and no pleural invasion (pl[-]). Results: 10 (12%) of 82 tumors were found to be invasive by histopathology, with the following positive indicators: n(+) in 5 (6%), ly(+) in 3 (4%), v(+) in 2 (2%), and pl(+) in 6 (7%). The median 3D-C/T ratio was 0.39. The mean 3D-C/T ratios by pathological findings were as follows: n(+) 0.74 vs n(-) 0.35 (p < 0.01), ly(+) 0.74 vs ly(-) 0.36 (p ¼ 0.06), v(+) 0.58 vs v(-) 0.37 (p ¼ 0.27), and pl(+) 0.57 vs pl(-) 0.35 (p ¼ 0.04). The 3D-C/T ratios of invasive cancer vs noninvasive cancer were 0.71 and 0.34, respectively (p < 0.01). By ROC curve analysis, a 3D-C/T ratio cutoff value of 0.43 provided a sensitivity and specificity of 100% and 61%, respectively, for the diagnosis of invasive cancer. Conclusion: This was a pilot study that evaluated the usefulness of 3D-CT imaging for assessing the invasiveness of small lung adenocarcinomas. A prospective observational study of 3D-CT imaging for diagnosing invasive lung adenocarcinoma is warranted.

Effects of Pharmacist-Led Clinical Pathway/Order Sets on Cancer Patients: A Systematic Review

“…To be more specific, standardized care of cancer patients, which can also be defined as "care pathways," is needed in both the ward (Dear et al (2017)) and outpatients (Ekstedt et al (2019)), due to the complicated processes of chemotherapy and various treatment-related or postoperative complications. Thus, opportunities (Shabaruddin et al (2010); Busby et al (2011); Oyebode (2013); Flagg et al (2013); Kataoka et al (2017)) have emerged for hematology/oncology pharmacists, to optimize medication procedures (Shipman and Arzola (2010); Al Sudairy et al (2014)), according to guidelines.…”