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Khuram Ameen.  Good for Proximal Lesions  Yield low for peripheral nodules 10-20%

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Presentation on theme: "Khuram Ameen.  Good for Proximal Lesions  Yield low for peripheral nodules 10-20%"— Presentation transcript:

1 Khuram Ameen

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3  Good for Proximal Lesions  Yield low for peripheral nodules 10-20%

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5  20 % Risk For Pneumothorax  Some areas difficult to access  Inability to evaluate bronchial Anatomy

6  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  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

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9  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 pneumothorax 1 Source: Eberhardt, R, et al, CHEST June 2007: 1800-1805

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11  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 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  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

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17  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  Staging of non-small cell lung cancer  Diagnostic evaluation of endobronchial lesions, peripheral pulmonary nodules, mediastinal abnormalities  Guidance of endobronchial therapy

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24  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

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36  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

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