Diagnosis and Palliation for lung Cancer

Khuram Ameen

Routine Bronchoscopy

Good for Proximal Lesions

Yield low for peripheral nodules 10-20%

CT Guided Needle Biopsy

20 % Risk For Pneumothorax

Some areas difficult to access

Inability to evaluate bronchial Anatomy

Complications of CT Guided BiopsyTomiyams et al in Eur J Radiology July 2006

Data from 9783 biopsies was collected from 124 centers

Pneumothorax was the most common complication, and occurred in 2412 (35%) of 6881 cases

74 (0.75%) cases with severe complications

From a total of 62 patients with severe complications, 54 patients (0.55%) recovered without sequela

Super D Navigation Bronchoscopy

Electromagnetic Navigation Bronchoscopy® (ENB)™ extends the reach the bronchoscope to regions deep within the lung enabling physicians to locate small lung lesions for diagnostic testing and potential treatment. The system uses natural airway to access a lesion

ENB minimizes the need for more invasive, surgical procedures to access lung lesions in the distant regions of the lung

Navigation Bronchoscopy

Electromagnetic Navigation Bronchoscopy (ENB)

Using the patient’s natural airways, the i·Logic System provides the ability to diagnose, stage, and prepare to treat distal lung lesions in one procedure

Provides safe and efficient access for non-operable patients

Carries a 3% or less risk of pneumothorax1

Source:Eberhardt, R, et al, CHEST June 2007: 1800-1805

Navigation Bronchoscopy

In 83.9% the combination of PET-CT, ENB, and ROSE established a correct diagnosis

Steep learning curve with a diagnostic yield of 80% and 87.5% for the first 30 and last 30 procedures, respectively

Lesions ≤20mm and >20mm in diameter was 75.6% and 89.6% (p=0.06), respectively.

Advantages of i·Logic – Extended Reach

Navigate to peripheral lesions and biopsy for diagnosis

Stage lymph nodes for diagnosis and pre-operative planning

Place fiducial markers in and around tumors for radiation therapy

Place markers to facilitate VATS localization

Guide high dose radiation catheters

Marking Lesions for Surgical Resection

69 year female with granulomatous lung disease breast cancer and metastatic rectal cancer with an enlarging lung nodule

Radiology felt a needle would be difficult given small size of the lession

Marking Lesions for Surgical Resection

Marking Lesions for Surgical Resection

Endo-Bronchial Ultrasound

 Endobronchial ultrasound (EBUS) is a bronchoscopic technique that uses ultrasound to visualize structures within and adjacent to the airway wall

Two types of probes radial probe EBUS (RP-EBUS) convex probe EBUS (CP-EBUS)

Endo-Bronchial Ultrasound

Staging of non-small cell lung cancer Diagnostic evaluation of

endobronchial lesions, peripheral pulmonary nodules, mediastinal abnormalities

Guidance of endobronchial therapy

Radial Ultrasound

Radial Ultrasound

Combining EBUS and Navigation

Complement each other Improve diagnosis In a larger series involving 120

patients, the combined use of EMN and EBUS had a significantly higher yield (88%) in diagnosing the lesion than either modality alone▪ Eberhardt R, Anantham D, Ernst A, et al.

Multimodality bronchoscopic diagnosis of peripheral lung lesions: a randomized controlled trial. Am J Respir Crit Care Med 2007; 176:36- 41

Palliation

Pre and Post Stent

Bleeding Tumor treated with heat

X Ray Pre and Post

Spiration Valves for Prolonged Air Leak Post Lobectomy

Prolonged post-surgical air leaks (PAL) are conditions that complicate clinical management and increase healthcare costs. The FDA has approved the IBV Valve System (Spiration Redmond, WA) as a Humanitarian Use Device for the treatment of some types of PAL

Spiration Valve

Spiration Valve

Pre and Post

Pleurex For Malignant Effusion