Online Health Chat with Eduardo Oliveira, MD
January 29, 2015
Electromagnetic Navigation Bronchoscopy (ENB) is one of the more recent bronchoscopic tools for physicians to detect any lesion deep in the lung without surgery. The ENB procedure is a GPS-like technology that locates any lesion in the lung, and gives doctors the option to perform a biopsy and prepare treatment. The reinforced guide catheter extends beyond that of a standard bronchoscope, making it easier to access regions deep within the lung without any additional risks, where the traditional procedure couldn’t reach.
ENB provides advantages for multiple specialties such as Pulmonology, Thoracic Surgery, and Oncology.
Other uses for the procedure may include:
- Diagnosis of lung lesions
- Staging lymph nodes
- Placement of fiducial markers for radiation therapy
- Placement of markers to guide VATS
- Guidance of high does radiation catheters
Founded in 2001, the Interventional Pulmonology Program at Cleveland Clinic Florida is one of the top interventional programs in the state of Florida. Our highly specialized team of physicians provides a full spectrum of diagnostic and therapeutic services for the treatment of lung cancer and other benign conditions of the lung. We offer the most innovative diagnostic tools resulting in earlier diagnosis of lung disease and lung cancer. Earlier detection of lung cancer results in improved treatment outcomes and survival rates for the patients.
About the Speakers
Eduardo Oliveira, MD, is a Pulmonologist in the Department of Pulmonary Medicine and Head of the Section of Interventional Pulmonology at Cleveland Clinic Florida. His specialty interests include lung cancer, lung nodule, asthma, critical care medicine and interventional pulmonology involving airway stents, laser bronchoscopy, navigation bronchoscopy, autofluorescence bronchoscopy, pleuroscopy, EBUS, navigation bronchoscopy and bronchial thermoplasty. Dr. Oliveira received his medical degree from the Medical College of Teresopolis in Rio de Janeiro, Brazil. He completed a residency at Washington Hospital Center and his fellowship in Pulmonary and Critical Care Medicine at George Washington University.
Let’s Chat About Electromagnetic Navigation Bronchoscopy and Earlier Detection of Lung Cancer
Welcome to our "Electromagnetic Navigation Bronchoscopy: Earlier Detection of Lung Cancer" online health chat. Please submit your questions early. All questions will be addressed during the live chat at 12pm ET (12 pm CST) on Thursday, January 29.
About Electromagnetic Navigation Bronchoscopy
pelican21: Is this procedure covered by Medicare?
Eduardo_Oliveira,_MD: Yes it is covered by Medicare and most insurance carriers.
KK: 9/30/14 My husband has severe COPD, Dx'd 1998 (stopped smoking that day), with right lung reduction, 2/3 lung was removed. A 2013 consultation with UCLA Director of Lung Transplant program said he was "doing too well" at that time to need transplant, and furthermore, due to the right lung reduction surgery and adhesions they would not ever be able to transplant his right lung, only his "good" left lung. I tell you all this to ask: Could you use ENB etc on his Right Lung, or only on his Left Lung? He has had some recent new spots on lung CT Scans, some turned out to be scarring, latest spots may be due to latest exacerbation, no results yet on scan done yesterday. He has been told they could not do biopsy on him due to something, lung reduction I believe, and/or location of spots--? Not sure. Thanks very much.
Eduardo_Oliveira,_MD: It is difficult to say if Navigation can be done in his case or if biopsy is really needed. His complex pulmonary issues and prior major surgery do increase his risks of any invasive or minimally invasive lung procedures. If his team of doctors believe biopsy is needed, I would suggest consultation with a pulmonologist experience in those techniques so he/she can review the films and give a more educated opinion. We can perform navigation guided biopsy in patients with limited lung function but a detailed discussion about risks and benefits must occur.
Kcarlyle: What is the difference between an ENB and a traditional bronchoscopy?
Eduardo_Oliveira,_MD: ENB utilizes computer guidance to identify and locate lung lesions. The lesions are located by small catheters that are guided by the computer to the target. This is needed since the bronchoscopes are often too big to get to those small and distant areas of the lung. Navigation guided biopsy basically functions like the GPS in your car by guiding those small catheters to the target area (by planning the procedure on the CT scan of the chest and using the CT chest as the map) with great accuracy and precision. On the other hand regular, bronchoscopy can only go to the larger, more central breathing pipes, and although biopsy can be performed in distant lung areas using regular bronchoscopy it lacks accuracy and if lesions are small, they are often missed.
Process of ENB
Nineiron9: What can a doctor detect when performing an ENB other than lesions in the lungs?
Eduardo_Oliveira,_MD: ENB is mostly intended for lesions of the lung (Lung nodules, lung nodes among others). Computerized navigation guidance is used in other areas of medicine like in ablations for atrial fibrillation (heart), neurosurgery procedures among others.
Adka890: Is the process of having an ENB to check for lesions feel any different than having an ENB to place markers for radiation therapy? Will I feel any pain or discomfort?
Eduardo_Oliveira,_MD: The process is the same. The markers should cause no additional pain or discomfort and can be very helpful in guiding the radiation treatment in the lung. Those markers can also be placed to help surgeons find and remove small lung nodules of the lung. Overall, after the procedure, patients will report minimal symptoms like mild sore throat or cough which should resolve in 24 to 48 hours.
Rockfan2465: What is the recovery process after having an ENB procedure done?
Eduardo_Oliveira,_MD: Very similar to having a colonoscopy or regular bronchoscopy. In most cases patients, are awake a few minutes after the procedure and ready to go home in just a couple of hours.
MRQUARTERMAIN: I was diagnosed with lung cancer in February 2010 and had a successful surgery with Dr. Rice at Cleveland Clinic. I have had no problems since that time, and would like to know if there is a possibility of the cancer returning again?
Eduardo_Oliveira,_MD: I am glad you did well on surgery. In general once you have developed lung cancer most experts will perform surveillance with imaging for a period of time. This period of time will depend on your particular risk (smoking, cancer staging, cancer type etc). In many cases of early stage lung cancer (stages 1 and 2) surveillance with computerized tomography scans is done for about 5 years since this is the period with the highest likelihood of recurrence. In same cases, yearly CT scans will be recommended to continue to monitor for the development of a new lung cancer.
More information about surveillance can be obtained at the National Comprehensive Cancer Network (NCCN) website.
kasperek: I was given a x-ray of my lungs in January of 2014 and doctor noticed a nodule on the right side. When I had another one done in March nothing showed up on my x-ray. I also had a CT scan done and nothing showed. My primary doctor said it could be mucus or a shadow. What could this have been? and should I be concerned in the future for another x ray perhaps? Thank You.
Eduardo_Oliveira,_MD: It is not unusual to have shadows or nodules disappear on follow up CT's. This happens because many of those nodules are benign and often resolve with time. It may have been an infection, inflammation or as your primary doctor stated, a mucus plug. I do not see a major reason to be concerned and would follow-up your doctors advice regarding further follow-up.
Moderator: I'm sorry to say that our time with Eduardo Oliveira, MD, is now over. Thank you again, Dr. Oliveira for taking the time to answer our questions today about Electromagnetic Navigation Bronchoscopy: Earlier Detection of Lung Cancer.
To make an appointment with Eduardo Oliveira, Pulmonologist or any of the other specialists in the Department of Pulmonary Medicine at Cleveland Clinic Florida, please call 877.463.2010. You can also visit us online at http://my.clevelandclinic.org/florida.
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