clinical cases

[ONC2023]

---

Members do not see this ad.

For node-positive NSCLC on PET, do you always refer for EBUS or does it depend on how convincing the PET is?

Specifically, T1 primary tumor 2 cm with ipsilateral FDG-avid ipsilateral hilar node, SUV 3. Looks real.

NCCN guidelines say to do pathologic sampling for any stage II, but I'm wondering if that's done in the real world.

 

[gutonc]

For node-positive NSCLC on PET, do you always refer for EBUS or does it depend on how convincing the PET is?

Specifically, T1 primary tumor 2 cm with ipsilateral FDG-avid ipsilateral hilar node, SUV 3. Looks real.

NCCN guidelines say to do pathologic sampling for any stage II, but I'm wondering if that's done in the real world.

Yes. Especially because it's the difference between a IA2 (resection/SBRT only) and IIA/B (depending on AJCC 8/9) where you'd consider neoadjuvant chemo-IO (or Chemo-Osi) for appropriate patient.

I know that my thoracic surgeons wouldn't operate on this patient without a LN biopsy. I think you'd also be hard pressed to get neoadjuvant chemo-IO covered for a T1bN?.

Now, "back in the day" when it was just adjuvant chemo as your option, it would be totally OK to go to the OR with just the PET and do a mediastinoscopy prior to the resection. But in this day and age, a biopsy is mandatory unless there's other extenuating circumstances that prevent it.

I guess the other question I have is, how did you get path without a bronch in the first place? I can't get pulm to do a diagnostic bronch without a PET if I offer to pay a year of their kid's college tuition.

 

[gutonc]

1. Prayer and Ivermectin do not in fact cure NS-cHL.
2. I am batting .500 on Lorlatinib --> psychotic break patients.

 

[GUoncologist]

1. Prayer and Ivermectin do not in fact cure NS-cHL.
2. I am batting .500 on Lorlatinib --> psychotic break patients.

1. Show me randomized data you pharma mogul!
2. Have they tried ivermectin and prayer?

 

[gutonc]

1. Show me randomized data you pharma mogul!

We went through that already. They did 6 cycles of P+I and repeat PET showed Deauville 5. Starting 2nd line Nivo-AVD next week.

2. Have they tried ivermectin and prayer?

Mushrooms and meditation actually. Equally ineffective.