ROBOTIC GAMMA PROBE-ASSISTED DIAGNOSIS OF PROBLEMATIC LUNG NODULES
Mary Carrier, R. Douglas Adams.
TriHealth, Cincinnati, OH, USA.
OBJECTIVE: Lung cancer survival is stage dependent and significantly influenced by tumor size. Risk-driven Low Dose Computed Tomography (LDCT) screening for lung cancer improves survival in large part due to earlier detection. Up to 40% of LDCT-screened patients have newly discovered pulmonary nodules, however not all are malignant. Accurate diagnosis is essential to guide further therapy. Biopsy options are CT guidance, conventional/robotic bronchoscopy or surgical. In some patients, lesion size, characteristics or location render these techniques unsafe or predictably inaccurate. Such persons undergo staged imaging, a delay which can impact survival and has mental health consequences.
METHODS: The drop-in gamma probe is a localization technology useful in such patients. Under CT guidance, technetium is injected into the lesion and along a track to the pleural surface. In a same-day robotic operative procedure, the drop-in probe is used to localize the lesion. A wedge biopsy is performed, the presence of technetium in the vitro specimen confirmed, and a frozen section analysis is completed. Further therapy is diagnosis driven.
RESULTS: Seven consecutive patients successfully underwent the described technology. Pre-procedure, multi-disciplinary review concluded usual biopsy techniques were not sufficiently safe or accurate. Lesion characteristics, pathology and subsequent therapy are shown in Table 1. This localization technique added an average of five minutes to operative time and cost analysis is on-going.
CONCLUSIONS: This simple, safe and accurate technology is promising for biopsy of “problematic” lung nodules. Accurate diagnosis of such nodules will become increasingly important as LDCT scanning increases.
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