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‘A marriage of virtual and real bronchoscopy’

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Anne Paxton

Dr. Kim

Dr. Kim

February 2017—The molecular testing guidelines have been having a significant impact on surgical practices since they were issued, said thoracic surgeon Min Kim, MD, another webinar panelist. As practice at his institution, Houston Methodist Hospital, has evolved, Dr. Kim said, there has been an increasing need for minimally invasive ways of obtaining tissue from lung cancer patients.

“We know that we can provide a cure for patients with early-stage NSCLC, but for patients with more advanced disease, there’s a high recurrence.” So in addition to the customary diagnosis, staging, treatment, and surveillance, “we’ve been asked to provide tissue for molecular testing for more advanced lung cancer patients that we often did not see in the past,” said Dr. Kim, an assistant professor of surgery at Weill Cornell Medical College.

With the guidelines taking effect this year, “we will be providing molecular testing for all our patients for all stages of lung cancer.” He described how state-of-the-art surgical technology can ease and shorten the process of obtaining the necessary tissue.

As a case study, he played a video of a surgery he had performed on a stage IIIA lung cancer patient. “In the past, we would do a needle biopsy and then probably a mediastinoscopy through diagnosis and staging.” But to get the patient into treatment as quickly as possible in this case, the surgeons performed a super dimensional bronchoscopy and biopsy of the original lesion, plus endobronchial ultrasound needle biopsy.

“The concept is kind of a marriage of virtual bronchoscopy and real bronchoscopy,” Dr. Kim said. Using a CT image, he guided the catheter to the lesion, confirmed it with the fluoroscopy while in the operating room, then did multiple biopsies and supplied them to the pathologist. “That patient ended up getting started on treatment the following week. So basically in one procedure we were able to get all the information we needed.”

The same can be done, he showed, with endobronchial ultrasound and immunobiopsy of the mediastinal lymph nodes, allowing a diagnosis of the mediastinal lymph nodes.

Guidelines reset horizons of molecular testing in NSCLC

 

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