Electromagnetic Navigational Bronchoscopy
The superDimension electromagnetic navigational bronchoscopy system extends the reach of the bronchoscope to previously inaccessible areas of the lung using a 3-D "roadmap" of the patient's airways. The system takes advantage of natural airway access and enables physicians to find and biopsy tiny lung lesions, some of which are detected incidentally during scans for other conditions, as the following case study illustrates.
The technology, now available at Sacred Heart Medical Center, means less testing for patients and a streamlined process from suspicion to diagnosis to treatment of lung cancer.
Subject: Patient was a 55-year-old woman with a significant history of alcohol abuse, smoking, COPD and hypertension. While at a Portland hospital, she tripped and fell, fracturing her ankle. She was admitted to the hospital and became hypoxemic. A CT pulmonary angiogram was performed to rule out embolism. The CT detected a nodule in her right upper lobe, visible in the image below.
Diagnosis: The patient was referred to Karthik Mahadevan, MD, a pulmonologist with Oregon Lung Specialists LLC in Springfield. A review of her earlier CT showed a 12 mm by 8 mm nodule in the right upper lobe. Dr. Mahadevan performed electromagnetic bronchoscopy at Sacred Heart at RiverBend using the superDimension system to biopsy the small nodule. As a result, the patient was diagnosed with nonsmall cell lung cancer, and complete evaluation indicated clinical stage 1 disease.
Treatment: Eight days later, cardiothoracic surgeon Paul Koh, MD, of Sacred Heart's Oregon Heart & Vascular Institute performed minimally invasive video-assisted thoracoscopic (VATS) right upper lobectomy and hilar lymph node dissection. Pathologic evaluation of the resection specimens confirmed stage 1 disease.
Outcome: Following the procedure, the patient did well. A postoperative air leak was present, which resolved with conservative management by post-operative day five. She was subsequently discharged from RiverBend, and has done well in outpatient follow up with Drs. Mahadevan and Koh.
Pre-Operative Images of Lung Nodule