Alan Moy, MD Pulmonary Associates of Iowa City Mercy Hospital of Iowa City Electromagnetic...
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Transcript of Alan Moy, MD Pulmonary Associates of Iowa City Mercy Hospital of Iowa City Electromagnetic...
Alan Moy, MDAlan Moy, MDPulmonary Associates of Iowa Pulmonary Associates of Iowa
CityCityMercy Hospital of Iowa CityMercy Hospital of Iowa City
Electromagnetic Navigation Electromagnetic Navigation BronchoscopyBronchoscopy
A New Treatment for Patients with Peripheral Lung A New Treatment for Patients with Peripheral Lung LesionsLesions
Lung Cancer: An Epidemic?Lung Cancer: An Epidemic?
In U.S.: #1 cause cancer-related death1
#2 death behind heart disease1
More than breast, prostate, colon and pancreatic cancers combined1
87% of lung cancer deaths related to tobacco2
Sources: 1. Jemal A, et al., 20072. American Cancer Society, 2006
Lung Cancer: A Growing Lung Cancer: A Growing ProblemProblem
2007 estimates for US: > 213,000 new cases1
> 160,000 deaths1
45 million smokers in US
Lung cancer risk:2
20 times higher for male smokers 12 times higher for female smokers
The population is aging and the incidence of lung cancer will grow3
Sources: 1. Jemal A, et al., 20072. Ries L et al., 20033. American Cancer Society, Surveillance Research, 2006
Lung Cancer: Poor Lung Cancer: Poor PrognosisPrognosis
>75% of new cases have late-stage cancer (Stage III or IV)1
5-year survival rate
is only 15%2
65-70% Stage III or IV
Only 15%will survive
5 years
Sources: 1. Dubey S et al., 20062. Ries L et al., 2003
Early Diagnosis Offers HopeEarly Diagnosis Offers Hope
If diagnosed at Stage III or IV, 15% survival rate at 5 yrs1
If diagnosed at Stage I, 88% survival rate at 10 yrs1
92% survival rate if immediate removal of lesion1
Only 16% of lung cancer patients are diagnosed at an early, localized stage.2
0
20
40
60
80
100
15%
88%92%
SURVIVAL RATES
Source: 1. Intl Early Lung Cancer Action Program Investigators, 20062. Reis L, et al, 2003.
Early Stage AdvantageEarly Stage Advantage
STAGE I OR II LESION STAGE III OR IV LESION
SMALLER
DISTAL LOCATION
DISCREET
EASIER TO TREAT
SURVIVAL RATE = 88% @ 10 YEARS
LARGER
PROXIMAL LOCATION
ORGANIZED & WIDESPREAD
TOO LATE FOR EFFECTIVE TREATMENT
LIFE EXPECTANCY +/- 6 MONTHS
Source: 1. Intl Early Lung Cancer Action Program Investigators, 20062. American Cancer Society, Surveillance Research, 2006
Failure of BronchoscopyFailure of Bronchoscopy
500,000 bronchoscopies performed annually in the US1
65% of bronchoscopies fail to reach peripheral lesions2
Failure of bronchoscopy leads to more invasive diagnostic procedures
Source:1. Ernst et al., 20032. Schwarz Y et al., 2006
Current Approaches to Current Approaches to DiagnosisDiagnosis
MethodMethod LimitationsLimitationsWatchful Waiting Watchful Waiting Malignant CANCER can Malignant CANCER can
ADVANCE stageADVANCE stage
Sputum, CXR, CT, PETSputum, CXR, CT, PET No tissue collectionNo tissue collection
BronchoscopyBronchoscopy Limited reach and Limited reach and low diagnostic yieldlow diagnostic yield
Transthoracic Needle Transthoracic Needle Aspiration (TTNA)Aspiration (TTNA)
PneumothoraxPneumothoraxNot all patients are candidatesNot all patients are candidates
SurgerySurgery Non-therapeutic thoracotomyNon-therapeutic thoracotomyHighly invasiveHighly invasive
Not all patients are candidatesNot all patients are candidates
INVASIVE
Total Bronchial Access & Total Bronchial Access & NavigationNavigation
Expanding the boundaries of patient care
An electromagnetic navigation system that meets the unmet medical need for a minimally invasive procedure
Improved diagnostic yield of peripheral lung lesions and mediastinal lymph nodes1
Source: 1. Schwarz et al., 2006
inReach™ ProcessinReach™ Process
DICOM CD
PLANNING: Preparing for the
Procedure and Learning the Patient’s Anatomy
NAVIGATION : Tx Scope (2.8mm)
Bx/Tx
CT Scan :
inReach™ System: Navigation inReach™ System: Navigation PhasePhase
Position steerable navigation catheter near the target
Lock guide catheter in place and remove steerable navigation catheter
Insert endobronchial instruments through guide catheter
Use instruments to remove tissue samples
inReach™ inReach™ System ComponentsComponents
Guide Catheter
Steerable Navigation Catheter
inReach™ System inReach™ System ComponentsComponents
Location Sensor
inReach Planning Software
PatientSensors
inReach™ System inReach™ System AdvantagesAdvantages
Extended Reach
Access to peripheral lesions
Access to central lung lesions and mediastinal lymph nodes
Compatible with most endobronchial tools
Minimally invasive
inReach™ System inReach™ System AdvantagesAdvantages
Greater Clarity
Diagnostic yield of 69-74%1,2
Target peripheral lesions
Preview and determine path prior to procedure
Navigate and steer through multiple branches of the bronchial tree
Sources:1. Becker et al., 20052. Gildea et al., 2006
inReach™ System inReach™ System AdvantagesAdvantages
Multi-Use and Multi-
Specialty inReach advantages cross
several specialties
PULMONOLOGISTS
THORACICSURGEONS
RADIATIONONCOLOGISTS
inReach™ System Clinical inReach™ System Clinical ResultsResults
Effective
Successful diagnosis of peripheral lesions in 69-74% of inReach cases1
Even higher success rates for lymph nodes
1. Gildea et al., 2006
inReach™ System Clinical inReach™ System Clinical ResultsResults
Safe Pneumothorax rate of 2.3%
(similar to standard bronchoscopy)1
Published > 1 dozen published papers
Used in Multiple Centers
> 2000 patient cases worldwide
1. Eberhardt et al., 2007
Why the inReach™ System?Why the inReach™ System?
For Patients
Minimally invasive
Enables earlier diagnosis and earlier treatment decisions
Potential for lower complication rates
Why the inReach™ System?Why the inReach™ System?
For Physicians
Expanded options for accessing lung lesions
Improved steering through multiple branches of bronchial tree
Potential for planning multiple procedures
Ability to diagnose and stage distal lesions
Enhanced decision making for diagnostic and treatment options
Improved patient care with minimally invasive procedure
Faster route to diagnosis and treatment
Why the inReach™ System?Why the inReach™ System?
For Hospitals
Improved patient care
May reduce complication rates that can occur with more invasive options
Retained patients for treatment by:
Radiation oncologists Thoracic surgeons
Closing CommentsClosing Comments
Alan Moy, MDAlan Moy, MD
Mercy Hospital Iowa CityMercy Hospital Iowa City
Pulmonary Associates of Iowa Pulmonary Associates of Iowa CityCity
319-887-2873319-887-2873