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Courtesy Dr Andrew Renshaw

EBUS vs MEDIASTINOSCOPY

• Outpatient procedure

• Minimal downtime.

• No pain.

• Minimal risk/complication.

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OPTIONS FOR EVALUATION OF ALUNG NODULE/MASS

• Transthoracic needle aspiration/Core• Surgical• Traditional bronchoscopy with

fluoroscopy• Guided bronchoscopy• Radial EBUS.

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ELECTROMAGNETICNAVIGATION

BRONCHOSCOPY

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Navigation Bronchoscopy

• Inspiratory/Expiratory non contrast, same day CT with high sections(>500 slices)

• Procedure planning at workstation.

• Transfer to procedure tower.

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CRYO PROBE

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PDT: Therapeutic Uses in Lung Cancer

Indications Clinical Settings

Microinvasive/CIS NSCLC Screen-detectedcurative intentin patients that are poorsurgical candidates or refuse surgery.

Obstructing NSCLC Partially or fully obstructing disease

NCCN Guidelines

National Comprehensive Cancer Network; The NCCN Guidelines®;Version 2.2018,©

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Non-thermallaser light

Tissueuptake

and clearance

Photosensitizing Agent(IV Administration)

Relatively SelectiveRetention in Tumor

Tumor Tissue Destruction

Release of singletoxygen

Photodynamic Therapy Overview

LysosomesEnzyme leakageNucleus

SSB, SCE,DNA fragmentationGene induction

Intracellular effects of 1O2 (singlet oxygen)

MembraneLipid peroxidation

Inactivation ofmembrane-boundenzymesDepolarizationInitiation of apoptosis

Mitochondria

Mechanism of Action:PDT Effect within the Tumor Cell

PDT Light Dosimetry

200J/cm for interstitial therapy, or intraluminal therapy,

over 8 minutes and 20 seconds

DIOMED 630 PDT Laser

A range of quartz optical rigid and flexible fibers fitted with cylinder diffuser tips: 1.0cm

to 5.0cm (Optiguide® Fiber Optic)

OPTIGUIDE® FIber Optic

• Careful patient selection

• Patient is informed and consented

• Porfimer sodium usually injected Friday

• General anesthesia with LMA

• Laser light application usually Monday

• Debridement Wednesday, possibly Friday and Monday depending on tumor burden

• Follow up bronchoscopy starting in 3 months

How I do it

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COU

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Imaging

Case Scenario

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PULMONARY NODULE

• Solitary pulmonary nodule/mass

• No previous malignancy

• Done concurrently with bronchoscopy

• Activated if bronchoscopy is negative

• High NPV

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WHAT YOU LEARNED

• ROLE OF BT IN SEVERE ASTHMA

• ROLE OF BRONCHOSCOPY IN EVALUATION OF A LUNG MASS.

• OPTIONS TO EVALUATE THE MEDIASTINUM

• BLVR IN TREATING COPD/EMPHYSEMA

• GENETICS IN LUNG CANCER AND IPF

• ENDOBRONCHIAL INTERVENTIONS