RSNA 2015

Abstract Archives of the RSNA, 2015


SST03-01

Radiogenomic Evaluation of Lung Cancer-Are There Imaging Characteristics Associated with Lung Adenocarcinomas Harboring BRAF Mutations?

Friday, Dec. 4 10:30AM - 10:40AM Location: E451B



Darragh Halpenny, MBBCh, MRCPI, New York, NY (Presenter) Nothing to Disclose
Gregory J. Riely, New York, NY (Abstract Co-Author) Consultant, Boehringer Ingelheim GmbH Consultant, Merck & Co, Inc Consultant, F. Hoffmann-La Roche Ltd
Andrew J. Plodkowski, MD, Syracuse, NY (Abstract Co-Author) Nothing to Disclose
Anna Litvak, MD, New York, NY (Abstract Co-Author) Nothing to Disclose
Junting Zheng, New York, NY (Abstract Co-Author) Nothing to Disclose
Ramon E. Sosa, BA, New York, NY (Abstract Co-Author) Nothing to Disclose
Chaya Moskowitz, New York, NY (Abstract Co-Author) Nothing to Disclose
Michelle S. Ginsberg, MD, New York, NY (Abstract Co-Author) Nothing to Disclose
PURPOSE

BRAF mutations are found in 2% of non-small cell lung cancers (NSCLC) and are associated with responsiveness to treatment with targeted medical therapy. The purpose of this study is to identify computed tomography (CT) imaging features associated with BRAF mutation in lung cancer.

METHOD AND MATERIALS

The institutional review board approved this study. Patients presenting from 4/2/2004 - 6/3/2013 with BRAF mutated NSCLC were studied. Stage matched patients with NSCLC without BRAF mutation were used as controls. Thoracic CTs, performed at diagnosis, were retrospectively reviewed by 2 radiologists in consensus. Features assessed included: size, contour, consistency of the primary tumor, adjacent parenchymal changes (peri-lesional halo, obstructive changes, pleural tail); presence of thoracic lymphadenopathy, pleural effusion, pleural metastases and lymphangitic spread.

RESULTS

188 patients with NSCLC were included: 47 (25%) patients had a BRAF mutation. 141(75%) had non-BRAF mutated NSCLC: 47 EGFR mutations, 47 KRAS mutations, and 47 lesions without documented mutation. In each group, 30% patients were stage 1, 6% were stage 2, 26% were stage 3 and 38% were stage 4. BRAF patients were more likely to be older (p= 0.014), male (p=0.011) and have a smoking history (p<0.001) when compared to EGFR patients. There were no other demographic differences between the groups.BRAF lesions were most frequently solid: 37(79%), spiculated 22(47%) and peripheral 37(79%), however no imaging feature of the primary tumor was significantly different between BRAF and non-BRAF groups. Some ancillary imaging features were significantly associated with BRAF mutations when the BRAF group was compared to patients with KRAS mutations. BRAF patients were more likely to have a pleural effusion than KRAS patients 11(23%) vs 3(6%) p= 0.033. In addition, BRAF patients were more likely to have pleural metastases than KRAS patients 5(11%) vs 0(0%), p=0.045.

CONCLUSION

On CT evaluation, NSCLC with BRAF mutation is most frequently solid, spiculated and peripheral. No feature of the primary tumor can be used to differentiate BRAF lesions from other genetically distinct forms of NSCLC.

CLINICAL RELEVANCE/APPLICATION

The results provide the first description of the radiologic characteristics of BRAF mutated lung cancer, detection of which is important to identify patients who may benefit from targeted therapy.