Page 38 - Delaware Medical Journal - September/October 2020

TREATMENT
at the sub-centimeter nodules across different size ranges, they found that at a sensitivity of 90%, the specificity for nodules in the 4-10mm range is 48%, 6-10mm is 45%, 8-10mm is 52%, and for the 10mm nodules, it is 57%.6 Thus, the test was equally effective across nodules 1cm and under. This result suggests that sub-centimeter lung cancers have a similar biomarker expression and may behave similarly from a clinical standpoint.
The main limitation of this study
is the low statistical power due
to the low total number of sub- centimeter patients. Even at the largest institutions, only 100 patients or so can

Cancer Database, Surveillance, Epidemiology, and End Results
(SEER) database, and the Society of Thoracic Surgeons Database, track only T staging and do not record actual sizes. In the IASLC (International Association for the Study of Lung Cancer) 7th edition for lung cancer staging, T1 lung cancers included all cancers less than 2cm in size. The updated 8th edition divided T1 into T1a, T1b, and T1c. T1a represents cancers equal to and less than 1cm. However, these changes only went into effect as of 2018 and long-term follow- up is unknown.
Moving forward, we hope to accrue additional data to gain a better understanding of sub-centimeter lung cancers and to continue our successful collaboration with the Wistar Institute Cancer Center.
CONTRIBUTORS
■ KIRAN KATTEPOGU, MBBS, MPH. Research Assistant, Helen F. Graham Cancer Center & Research Institute at ChristianaCare.
■ RICHARD CAPLAN, PHD, Senior Biostatistician, The Value Institute at ChristianaCare.
■ LOUISE C. SHOWE, PHD, Professor in Molecular and Cellular Oncogenesis, Wistar Institute Cancer Center.
■ PATRICIA SWANSON, Project Manager, Cawley Center for Translational Cancer Research, Helen F. Graham Cancer Center & Research Institute at ChristianaCare.
■ CHARLES MULLIGAN, MD, Chief of Thoracic Surgery, Helen F. Graham Cancer Center & Research Institute at ChristianaCare.
■ BRIAN NAM, MD, Department of Thoracic Surgery, Helen F. Graham Cancer Center & Research Institute at ChristianaCare, Wistar Institute Adjunct Faculty and Wistar Cancer Center Affiliate Member.
REFERENCES
1. Siegel, R., Miller, K., Jemel, A. Cancer Statistics 2020. CA A Cancer Journal for Clinicians. Vol. 70, No.1, pp 7-30, 2020.
2. The National Lung Cancer Trial Research Team. Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening. New England Journal of Medicine: 365: 395-409, 2011.
3. Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: from the Fleischner Society 2017. Radiology 284(1):228-243, 2017.
4. Groheux et al. FDG PET-CT for Solitary Pulmonary Nodule and Lung Cancer: Literature Review. Diagnostic and Interventional Imaging 97(10):1003- 1017,2016.
5. Liu et al. Prognostic Value of 18F-FDG PET/CT in Surgical Non-Small Cell Lung Cancer: A Meta-Analysis. PLOS One 11(1), 2016.
6. Kossenkov et al. A Gene Expression Classifier from Whole Blood Distinguishes Benign from Malignant Lung Nodules Detected by Low-Dose CT. Cancer Research 79(1) 263-273, 2019.
7. Choi, Humberto, et al. Models to Estimate the Probability of Malignancy in Patients with Pulmonary Nodules. Annals of the American Thoracic Society15:1117-1126, 2016.
230
Del Med J | September/October 2020 | Vol. 92 | No. 5