1. Diagnosis and Palliation for lung Cancer
Khuram Ameen
Diagnosis and Palliation for lung Cancer

3. Routine Bronchoscopy Good for Proximal Lesions
Yield low for peripheral nodules 10-20%

5. CT Guided Needle Biopsy
20 % Risk For Pneumothorax
Some areas difficult to access
Inability to evaluate bronchial Anatomy

6. Complications of CT Guided Biopsy Tomiyams 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

7. 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

8. Navigation Bronchoscopy

9. 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:

11. 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.

12. 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

13. 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

14. Marking Lesions for Surgical Resection

15. Marking Lesions for Surgical Resection

17. 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)

18. Endo-Bronchial Ultrasound
Staging of non-small cell lung cancer
Diagnostic evaluation of endobronchial lesions, peripheral pulmonary nodules, mediastinal abnormalities
Guidance of endobronchial therapy

22. Radial Ultrasound

23. Radial Ultrasound

24. 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

25. Palliation

31. Pre and Post Stent

34. Bleeding Tumor treated with heat

35. X Ray Pre and Post

36. 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

37. Spiration Valve

38. Spiration Valve

39. Pre and Post

41. Pleurex For Malignant Effusion