Friday 18 October 2019

Abstract

Body: Early detection of breast cancer decreases mortality. Average risk women are recommended to begin annual screening at age 40 by American College of Radiology (ACR) Guidelines. For women who are at higher than average risk, earlier and/or more intensive screening is recommended. Several populations are currently recognized as being at increased risk for breast cancer, those with: genetic mutations that predispose to breast cancer and their untested first-degree relatives; strong family history of the disease (calculated life-time risk of 20% or more); exposure to mantle or chest radiation at young age; personal history of breast cancer; diagnosis of atypia or LCIS at breast biopsy; African American ancestry; and dense breast tissue. In general, mammographic surveillance will begin earlier in these populations, usually around age 30. Breast MRI is the most sensitive method of cancer detection and should be recommended annually for those genetically predisposed, exposed to chest RT at young age, with elevated calculated life-time risk, and with a personal history of breast cancer and dense tissue or diagnosed before age 50. Others with a history of breast cancer and those with atypia at biopsy should consider annual MRI surveillance, especially if other risk factors are present. All women, especially black women and those of Ashkenazi Jewish decent, should be assessed for risk no later than age 30. Learning Objectives: to understand which women are at elevated risk; to understand use of various modalities for screening higher risk women; to understand supplemental screening options in women of higher than average risk. Reference 1. Monticciolo DL, Newell MS, Moy L, Niell B, Monsees B, Sickles EA. Breast cancer screening in women at higher than average risk: recommendations from the American College of Radiology. J Am Coll Radiol. 2018; 15:408–414. 26 Clinical Radiology Orals Editorial material and organization © 2019 Royal Australian and New Zealand College of Radiologists. Copyright of individual abstracts remains with the authors. Friday 18 October 2019, 1530–1700, Concurrent Session 2.4.1 – Lung 1 Repeat microwave ablation for lung cancer – How many is too many? A Benard, M Sathi and K Steinke University of Queensland, Kallangur, Queensland, Australia, Department of Medical Imaging Research Office, Royal Brisbane and Women’s Hospital, Herston, Brisbane, Queensland, Australia, Department of Medical Imaging, Royal Brisbane and Women’s Hospital, Herston, Brisbane, Queensland, Australia Learning Objectives: To illustrate how multiple MWA sessions might be effectively integrated into mainstay and adjunct therapy in long-term treatment of lung malignancy. Background: In the last two decades, successful MWA treatment of primary and secondary lung cancers has occurred.(1–5) Support is increasing for the scope and efficacy of image-guided thermal ablation with promising results in Stage 1 Primary NSCLC.(6–9) MWA complications include local chest wall thermal damage and pain, pneumothorax, haemorrhage, pleural effusion and infection.(10) Several studies suggest using MWA as a viable treatment option in patients unsuitable for surgical management.(2, 11–14) Imaging Findings or Procedure Details: A 60yo female patient was diagnosed with lung cancer 6 times between 2001 and 2018. Treatment began with a right middle and lower lobectomy (2001) for a poorly differentiated large cell carcinoma in the intermediate bronchus of the right middle lobe (RML). The patient’s residual lung function, on a background of COPD, dictated further treatment options. Subsequent treatment included four MWA sessions (2011, 2012, March 2017 and October 2017), and radiotherapy in August 2018. The first two MWA sessions consisted of ablations of 2.5 and 3 minutes respectively at 90 W each. The 2011 lesion was an unbiopsied enlarging 18 mm lesion of ground glass opacity in the LLL. The 2012 lesion was a 10 mm adenocarcinoma in the RUL, histology confirmed by CT-guided core biopsy. In March 2017, a 2.5 minutes at 80 W ablation occurred on an unbiopsied new spiculated solid FDG-PET-avid 9.2 mm lesion in the LLL. Finally, in October 2017, the patient had a 3.5 minutes ablation at 60 W to an 11 mm adenocarcinoma in the LUL, biopsy performed at the time of ablation. Complications during MWA included pneumothorax, managed conservatively twice and ICC insertion once, limited self-resolving alveolar haemorrhage without associated haemoptysis twice and a skin burn. Follow-up modalities were timeframe dependent and included CXR and low-dose CT within 24 hours of each procedure, with long term follow-up CT at 3, 6 and 12 months and FDGPET at 12 months. All thermal ablations successfully achieved local tumour control. Currently the patient is recovering from conventional external beam radiotherapy to a new central parahilar adenocarcinoma in the LUL in July 2018, with stable respiratory function and serial CTs. Conclusion: MWA, a safe and effective treatment for Stage 1 NSCLC, can be used sequentially in patients unsuitable for surgical management, carrying limited morbidity, preserving vital lung function and quality of life as in the case presented. References 1. Crombe A, Buy X, Godbert Y, Alberti N, Kind Ml, Bonichon Fo, et al. 23 Lung Metastases Treated by Radiofrequency Ablation Over 10 Years in a Single Patient: Successful Oncological Outcome of a Metastatic Cancer Without Altered Respiratory Function. Cardiovasc Intervent Radiol. 2016;39:1779–84. 2. Sofocleous CT, Sideras P, Petre EN, Solomon SB. Ablation for the management of pulmonary malignancies. AJR American journal of roentgenology. 2011;197(4):W581–9. 3. Schneider T, Heussel CP, Herth FJ, Dienemann H. Thermal ablation of malignant lung tumors. Deutsches Arzteblatt international. 2013;110(22):394–400. 4. Pua B, Thornton R, Solomon S. Ablation of pulmonary malignancy: current status. J Vasc Interv Radiol. 2010;21(8): S223–32. 5. Wolf FJ, Grand DJ, Machan JT, Dipetrillo TA, Mayo-Smith WW, Dupuy DE. Microwave ablation of lung malignancies: effectiveness, CT findings, and safety in 50 patients. Radiology. 2008;247(3):871–9. 6. Yahya S, Ghafoor Q, Stevenson R, Watkins S, Allos B. Evolution of Stereotactic Ablative Radiotherapy in Lung Cancer and Birmingham’s (UK) Experience. Medicines. 2018;5(77). 7. Liu BD, Ye X, Fan WJ, Li XG, Feng WJ, Lu Q, et al. Expert consensus on image-guided radiofrequency ablation of pulmonary tumors: 2018 edition. Thoracic cancer. 2018;9 (9):1194–208. 8. Shyn PB. Is Image-guided Thermal Ablation Ready for Treatment of Stage 1 Non-Small Cell Lung Cancer? Radiology. 2018;289(3):871–2. 9. Uhlig J, Ludwig JM, Goldberg SB, Chiang A, Blasberg JD, Kim HS. Survival Rates after Thermal Ablation versus Stereotactic Radiation Therapy for Stage 1 Non–Small Cell Lung Cancer: A National Cancer Database Study. Radiology. 2018;289(3):862– 70. 10. Vogl TJ, Nour-Eldin NA, Albrecht MH, Kaltenbach B, Hohenforst-Schmidt W, Lin H, et al. Thermal Ablation of Lung Tumors: Focus on Microwave Ablation. RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin. 2017;189(9):828–43. 11. Sidoff L, Dupuy DE. Clinical experiences with microwave thermal ablation of lung malignancies. International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group. 2017;33(1):25–33. 12. Liu H, Steinke K. High-powered percutaneous microwave ablation of stage I medically inoperable non-small cell lung cancer: a preliminary study. Journal of medical imaging and radiation oncology. 2013;57:466–74. 13. Yang X, Ye X, Zheng A, Huang G, Ni X, Wang J, et al. Percutaneous microwave ablation of stage I medically inoperable non-small cell lung cancer: clinical evaluation of 47 cases. Journal of surgical oncology. 2014;110:758–63. 14. Yang X, Ye X, Huang G, Han X, Wang J, Li W, et al. Repeated percutaneous microwave ablation for local recurrence of inoperable Stage I nonsmall cell lung cancer. Journal of cancer research and therapeutics. 2017;13(4):683–8. Clinical Radiology Orals 27 Editorial material and organization © 2019 Royal Australian and New Zealand College of Radiologists. Copyright of individual abstracts remains with the authors. Clinical outcomes of CT-guided lung biopsy and diagnostic agreement with bronchoscopic tissue biopsy in suspicious lung lesions C Dunn, M Sathi, Y Mellam, J Rich and K Steinke Mater Hospital Brisbane, South Brisbane, Queensland, Australia, Department of Medical Imaging Research Office, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia, Redcliffe Hospital, Redcliffe, Queensland, Australia, Department of Medical Imaging, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia Purpose: To investigate a suspicious lung lesion, it is imperative to collect a large enough tissue sample to obtain unequivocal histopathology and immunohistochemical diagnosis. The methods of tissue sampling depend on patients’ comorbidities, lesion location, and operators’ skills. Endobronchial ultrasound (EBUS) is the current gold standard due to its safety. However, CT-guided lung biopsy (CTLB) is preferred in lesions that are peripheral or not accessible with EBUS. Pneumothorax and pulmonary haemorrhage commonly occur in CTLB. This study aims to assess clinical outcomes, complications, and agreement of tissue diagnoses between CTLB with EBUS in patients with suspected lung malignancy. Methods and Materials: This is a retrospective cross-sectional study. Patients who underwent EBUS followed by CTLB between January 2014 and December 2018 were evaluated. Clinical information including lesion details, complications, histopathological diagnoses, and treatment outcomes were obtained. Data was entered into Microsoft Excel spreadsheets and statistical analysis was performed using SPSS version 25. Results: Ninety-two patients were inc