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• W4387247925 abstract "SESSION TITLE: Procedures Case Report Posters 3 SESSION TYPE: Case Report Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm INTRODUCTION: Development of safe and accurate modalities to evaluate lung nodules has become increasingly important as lung screening programs and low dose CT studies are detecting more clinical stage Ia lung cancers. Conventional Bronchoscopy or Image-guided transthoracic needle aspiration (TTNA) have served as useful diagnostic tools, but diagnostic yield in peripheral pulmonary lesions (PPL) has remained low. For this reason, the advent of Robotic-assisted Electromagnetic Navigational Bronchoscopy has improved the evaluation of PPLs. Our case demonstrates the use of Endoluminal System (ION) Robotic Assisted Bronchoscopy (RAB) to facilitate early diagnosis of adenocarcinoma in an elderly female. CASE PRESENTATION: 79-year-old female non-smoker with a past medical history of breast cancer (lumpectomy with axillary dissection in 2008), hypertension, stroke and hyperlipidemia presented for evaluation of long-standing lung nodules routinely monitored by her primary physician. Most recent CT of the chest done October 2022 showed an increase in a right upper lobe (RUL) mass from 3.2 x 2.1 cm to 3.9x2.4 cm with an additional stable RUL nodule and scattered 2-5 mm nodules. Patient was scheduled for a ION-RAB with biopsy and intraoperative 3D fluoroscopy, along with a fiducial soaked in ICG placement. Intraoperative frozen section demonstrated atypical cells with lipidic growth consistent with adenocarcinoma in situ. Fourteen days later, patient underwent a right upper lobe (RUL) apical and posterior segmentectomy with recognition of fiducial marker. Patient had an uncomplicated postoperative course. DISCUSSION: The use of ION endoluminal system is safe and effective diagnostic and potentially therapeutic system for early-stage lung cancers. Intraoperative localization of ground glass opacities and lung nodules facilitated by deployment of fiducial soaked in ICG under fluoroscopic guidance not only facilitate the localization but also helps to confirm post resection margins. The Indocyanine Green is also useful to demarcate intersegmental planes favoring sub lobar anatomic resection, preserving lung parenchyma and reducing the rates of complications. CONCLUSIONS: The ION-RAB system has demonstrated better yields for diagnosis of central and peripheral lesions ICG-Fiducial marking allows for intraoperative real time localizations and resection of small lung lesion. We believe that. Therapeutic applications such as microwave ablation or other type of energy will be also possible through similar platforms encouraging ongoing research. REFERENCE #1: DIK Fielding, F Bashirzadeh, JH Son, M Todman, A Chin, L Tan, et al. First human use of a new robotic-assisted fiber optic sensing navigation system for small peripheral pulmonary nodules. Respiration, 98 (2019), pp. 142-150, 10.1159/000498951 REFERENCE #2: L Yarmus, J Akulian, M Wahidi, A Chen, JP Steltz, SL Solomon, et al. A prospective randomized comparative study of three guided bronchoscopic approaches for investigating pulmonary nodules: the PRECISION-1 study REFERENCE #3: R Velazquez, A Martin, M Abu Hishmeh, L DeLorenzo, S Singh Dhillon, K Harris. Placement of markers to assist minimally invasive resection of peripheral lung lesions. Annals of Translation Medicine. Vol 7 No 15. August 2019 DISCLOSURES: No relevant relationships by Adolfo Alvarez No relevant relationships by Cynthia Espinosa No relevant relationships by Fernando Safdie" @default.
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• W4387247925 date "2023-10-01" @default.
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• W4387247925 title "ROBOTIC-ASSISTED ION BRONCHOSCOPY IN THE DIAGNOSIS OF EARLY-STAGE LUNG ADENOCARCINOMA WITH ICG-FIDUCIAL MARKER FOR SURGICAL VS RADIATION PLANNING" @default.
• W4387247925 doi "https://doi.org/10.1016/j.chest.2023.07.3527" @default.
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