Image-guided Percutaneous Ablation of Lung Malignancies: A Minimally Invasive Alternative for Nonsurgical Patients or Unresectable Tumors

Evaluation of deployment capability of a novel outside-the-scope, detachable catheter system for ablation of lung lesions in ex vivo human lung models

Objectives

Effective transbronchial ablation of lung nodules requires precise catheter delivery to the target lesion and freedom from the bronchoscope for safety throughout the procedure and to allow for multiple catheter insertions. A fully detachable, outside-the-scope (OTS) probe system was developed that attaches to a flexible bronchoscope. Using this system, the operator can deploy the probe in the target and completely detach it from the scope. Our aim was to demonstrate the endobronchial deployment accuracy and feasibility of an OTS, detachable, simulated ablation catheter driven to peripheral lung targets in ex vivo–ventilated human lung models.

Methods

A balloon catheter inflated with radiopaque contrast was used as a simulated peripheral target in freshly explanted lungs from lung transplant recipients. A simulated ablation catheter was positioned outside and aligned to the tip of the bronchoscope using the OTS system. Under fluoroscopic guidance, the bronchoscope and the catheter were driven toward the target in mechanically ventilated lungs. Once the catheter tip was confirmed within the target, the OTS system was released and the probe was detached from the scope. The bronchoscope was retracted and fluoroscopy was used to confirm the position of the catheter.

Results

Twelve peripheral targets were simulated. The ablation catheter was successfully deployed with its tip positioned within 5 mm from the target and confirmed stability during multiple cycles of ventilation.

Conclusions

A novel, detachable, OTS system can be successfully deployed in peripheral lung targets with potential clinical applications for multiple procedures in advanced bronchoscopy where scope freedom is advantageous.

National Utilization, Survival, and Costs Analysis of Treatment Options for Stage I Non-Small Cell Lung Cancer: A SEER-Medicare Database Analysis

RATIONALE AND OBJECTIVES

To compare utilization, outcomes, and costs of surgery, radiation therapy, and percutaneous ablation for the treatment of stage I non-small cell lung cancer (NSCLC).

MATERIALS AND METHODS

Using 2006-2016 Medicare-linked Surveillance, Epidemiology, and End Results (SEER) databases, stage I NSCLC patients who underwent surgery, radiotherapy, or percutaneous ablation were identified using relevant billing codes. National utilization rates were determined. Overall survival for treatment arms were compared using log-rank test and Cox-proportional hazard modeling. Mean direct costs for each treatment strategy during the first year after diagnosis were compared using Analysis of Variance.

RESULTS

A total of 15,847 Stage I NSCLC patients were identified; mean age at diagnosis was 75.5 years (minimum age = 66 years) and 59.2% were female. A total of 10,732 patients (67.7%) underwent only surgery, 5013 (31.6%) only radiotherapy, and 102 (0.6%) only ablation. Utilization of surgery and ablation decreased while radiotherapy utilization increased from 2007 to 2015 (p < 0.0001). Compared to the ablation group, overall survival was greater for the surgery group (HR: 0.7, 95% CI of HR: 0.6-0.9, p = 0.0047) and lower for the radiotherapy group (HR: 1.4, 95% CI of HR: 1.1-1.8, p = 0.002). The mean first year cost of therapy for ablation = $11,976) was significantly less (p < 0.05) than for radiotherapy ($15,447) and surgery ($22,669).

CONCLUSION

In Medicare patients with stage I NSCLC, the utilization of radiation therapy has increased and surgery has declined, while utilization of percutaneous ablation has remained uniformly low. Although overall survival is best for surgery, then ablation, and then radiation therapy, first year treatment costs are lowest for ablation.

A Case Analysis on CT Guided Percutaneous Lung Puncture Biopsy of Lymphocyte Mesenchymal Pneumonia

OBJECTIVE

To explore the application and diagnostic value of high-resolution CT in the process of lymphocytic interstitial pneumonia clinical diagnosis, and analyze one case of CT-guided percutaneous lung biopsy lymphocytic interstitial pneumonia.

METHODS

The medical record of a patient with lymphocyte interstitial pneumonia (LIP) who came to the clinic on 2014-04-22 were analyzed and summarized retrospectively.

RESULTS

The patient was a 55 years old female farmer. The CT-guided percutaneous lung biopsy was performed at her first visit; on 2014-07-09, the patient returned to our outpatient clinic with the main complaint of "1 week of coughing and blood in sputum and phlegm". Pathology consultation report from the PLA General Hospital on 2014-07-29 showed: (right lower lung) pneumonic pseudo-tumor; Zhejiang First Hospital's pathology consultation report on 2014-08-11 showed: lymphocyte interstitial pneumonia.

CONCLUSION

The diagnosis of lymphocyte interstitial pneumonia (LIP) with high-resolution CT may be used to increase its clinical diagnosis rate, reduce misdiagnosis and improve early detection.

Serum proton NMR metabolomics analysis of human lung cancer following microwave ablation

BACKGROUND

To find potential serum biomarkers of microwave ablation (MWA) for treatment of human lung cancer by 1H nuclear magnetic resonance (NMR)-based metabolomics analysis.

METHODS

Serum specimens collected from 43 healthy individuals, 39 patients with advanced non-small cell lung cancer (NSCLC) and 38 NSCLC patients treated with MWA, were subjected to 1H NMR-based metabolomics analysis. Partial least squares discriminant analysis was used to analyze the data.

RESULTS

Compared with healthy controls, NSCLC patients showed significantly elevated serum levels of lactate, alanine, glutamate, proline, glycoprotein, phenylalanine, tyrosine and tryptophan, and markedly decreased serum levels of glucose, taurine, glutamine, glycine, phosphocreatine and threonine (p < 0.05). MWA treatment reversed the metabolic profiles of NSCLC patients towards the control group.

CONCLUSIONS

1H NMR-based metabolomics analysis enhanced the current understanding of the mechanisms involved in NSCLC, and uncovered the therapeutic potential of MWA for treatment of NSCLC. The above disturbed serum metabolites were proposed to be the potential biomarkers that may help to predict NSCLC and to evaluate the efficacy of MWA in the treatment of NSCLC.

Screening for lung cancer: to be or not to be covered by medicare?

The National Lung Cancer Screening Trial (NLST) found a reduction in lung cancer mortality in high-risk patients aged 55 to 74 who were screened with low-dose computed tomography (LDCT) rather than chest x-ray. This reduction was 20% after 6.5 years and 16% after 7.5 years, with a 6.7% reduction in all-cause mortality after 6.5 years. The US Preventive Services Task Force recommended LDCT screening for people aged 55 to 80 who currently smoke or had quit within the last 15 years and who have a history of at least 30 pack-years of smoking. Advocates are urging Medicare to cover the cost of screening for that same targeted population, but the Medicare Evidence Development and Coverage Advisory Committee recommended against coverage, expressing their lack of confidence that the benefits would outweigh the risks for the Medicare patients likely to be screened. Data that support and refute the advocacy position regarding Medicare coverage for LDCT screening are presented. The likely benefits and risks for Medicare patients are discussed in the context of NLST data, other research findings, comparisons between NLST patients and Medicare patients of the same age and smoking histories, and Medicare policies.