SESSION TITLE: Bronchology/Interventional Student/Resident Case Report Posters I
SESSION TYPE: Medical Student/Resident Case Report
PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM
INTRODUCTION: Electromagnetic navigational bronchoscopy (ENB) is a promising new technique , which enables physicians to access pulmonary lesions, previously inaccessible, for both biopsy and fiducial placement. With ENB’s increasing ability for diagnosis via biopsy, this may have an impact for prognosis and treatment, in certain instances. This additional benefit is without added risk, and may even decrease risks, as ENB has been documented to have a more favorable safety profile than other forms of biopsy and fiducial placement1.
CASE PRESENTATION: A 69 year old male with previously diagnosed with stage IIIA multifocal adenocarcinoma with a dominant mass in the posterior right upper lobe. He was treated with chemotherapy and consolidative stereotactic body radiation therapy (SBRT) with excellent response, and the dominant mass was undetectable. Since that time, he underwent serial imaging for oncologic surveillence, and follow up CT evaluation noted an enlarging right middle lobe nodule, ultimately PET positive, which was assumed to be recurrence of disease. Due to patient preference and previous response, treatment with SBRT was chosen, and fiducial placement was planned. Biopsy would also be performed at that time to confirm recurrence. The location of the lesion made other means of biopsy and fiducial placement very high risk. Due to these factors, superDimension® inReach ENB was chosen for both procedures. Fiducials were placed successfully, absence of pneumothorax was confirmed, and the biopsy was positive for poorly differentiated large cell neuroendocrine carcinoma, a new primary, with new implications for treatment and outcomes.
DISCUSSION: Without ENB, this lesion would have been unable to safely be biopsied, and in this case, the biopsy not only confirmed a new primary, but a rare one as well. This had therapeutic and prognostic implications, as large cell neuroendocrine tumors tend to have a much poorer prognosis2. These malignancies are also treated similar to small cell carcinomas, due to similar pathologic features and their aggressive nature2. While the patient declined chemotherapy, its use is only justified with the biopsy findings of the new primary. In this particular case, the use of ENB changed the diagnosis, prognosis, and treatment course.
CONCLUSIONS: ENB is a safe and effective means of biopsy and fiducial placement, and is strongly recommended for patients with lesions inaccessible via other conventional means, as this may have an impact on patient outcomes and care.
Reference #1: Leong S, Ju H, Marshall H, Bowman R, Yang I, Ree AM, Saxon C, Fong KM. "Electromagnetic navigation bronchoscopy: A descriptive analysis." J Thorac Dis 2012;4(2):173-185.
Reference #2: Veronesi, G., U. Morandi, M. Alloisio, A. Terzi, G. Cardillo, P. Filosso, F. Rea, F. Facciolo, G. Pelosi, and S. Gandini. "Large Cell Neuroendocrine Carcinoma of the Lung: A Retrospective Analysis of 144 Surgical Cases." Lung Cancer 53.1 (2006): 111-15.
DISCLOSURE: The following authors have nothing to disclose: John Brady, Richard Chang, Shari Rudoler
SuperDimensionÂ® inReach Electromagnetic Navigational Bronchoscopy is not, at present, considered standard of care for biopsy of pulmonary lesions and fiducial placement, and would be therefore considered investigational.