Thoracoscopic port locations for video camera and surgical instruments.
The CT-guided percutaneous lung biopsy is used to obtain tissue samples from a suspicious nodule or mass for microscopic evaluation. This CT “slice” shows s fine needle traversing the skin, chest wall and lung to reach a small nodule; samples of tissue are aspirated through the needle.
The upper arrow points to the lung nodule the lower one to lymph nodes at the root of the lung (hilum), identifying possible spread of the tumor.
Video Assisted Thoracic Surgery (”VATS”) enables surgeons to identify and remove suspicious lung nodules through two or three small (1/4 to 1/2inch) incisions. This minimally invasive approach is often the definitive diagnostic procedure which removes the abnormality and provides ample tissue for a definitive diagnosis. It is performed in the operating room, under general anesthesia and usually requires a 1-2 day hospital stay.
Among the new diagnostic modalities available to chest physicians, Endo Bronchial Ultra Sound (EBUS) has unquestionably had the most profound impact. EBUS makes it possible to insert a fine needle under visual control, into a suspicious lymph node or lung mass, way inside the body, to obtain tissue samples for diagnostic evaluation.
The tip of the flexible EBUS bronchoscope has an ultrasound probe (brown) and a biopsy needle protruding from it’s sheath.
Above on the left is a CT scan showing a suspicious lung nodule. On the right is a corresponding slice of a PET/CT showing increased metabolic activity (bright yellow color) of the same nodule.
Our state-of-the-art Light Speed 64 Slice Computed Tomography Scanner
Pulmonary function tests are a group of tests that measure how well the lungs take in and release air and how well they move gases such as oxygen from the atmosphere into the body's circulation.
How the test is performed?
Spirometry measures airflow. By measuring how much air you exhale, and how quickly, spirometry can evaluate a broad range of lung diseases. In a spirometry test, while you are sitting, you breathe into a mouthpiece that is connected to an instrument called a spirometer. The spirometer records the amount and the rate of air that you breathe in and out over a period of time. For some of the test measurements, you can breathe normally and quietly. Other tests require forced inhalation or exhalation after a deep breath. Sometimes you will be asked to inhale the substance or a medicine to see how it changes your test results.
Lung volume measurement can be done in two ways:
The most accurate way is to sit in a sealed, clear box that looks like a telephone booth (body plethysmograph) while breathing in and out into a mouthpiece. Changes in pressure inside the box help determine the lung volume.
Lung volume can also be measured when you breathe nitrogen or helium gas through a tube for a certain period of time. The concentration of the gas in a chamber attached to the tube is measured to estimate the lung volume.
Flexible bronchoscopy is a procedure that enables your physician or surgeon to examine the major air passages of the lungs. This allows your physician to evaluate your lungs and take small samples of tissue or fluid, if necessary. Usually the procedure is performed after you are mildly sedated and your nose or mouth is numbed. Your physician will then insert a bronchoscope, which is a flexible lighted tube about the width of a pencil, through your nose or mouth and into your windpipe. A small channel in the instrument allows tissue and fluid samples to be collected when appropriate.
Thoracoscopic view of a lung nodule being “wedged out”.
A PET/CT of the whole body shows increased uptake in a suspicious lung nodule as well as normal uptake in the heart, brain and urinary bladder.
Computed tomography (CT) is a diagnostic tool that uses x-rays and computers to generate detailed three dimensional images of any part of the body. What does the term "slice" mean? A "slice" refers to one horizontal section of tissue. The more slices an image has, the more opportunity there is for specialists to detect small nodules(benign or cancerous), in the lungs. Slices scanned by 64-slice CT are twice as thin as those scanned by 32-slice CT, which are more commonly found in other hospitals and cancer centers. How does a patient benefit from a 64-Slice CT? Thanks to The Westchester Lung Nodule Center’s ® 64-slice CT technology, doctors can detect nodules at a much smaller size than ever before-as tiny as a grain of rice. In addition, we can scan a patient with a complete 64-slice CT scan in fewer than 10 seconds. This means that even patients with severe breathing problems are able hold their breath for the required time. With traditional CT, lesions and nodules can be missed while a patient is taking a breath. With the new scanner, sharp, high-resolution, sub-millimeter slices are produced in a single, short breath-hold. Radiologists can combine the slices into 3-D color images that enable them to get a more accurate picture of the internal anatomy. They can also see areas from different vantage points, which is especially beneficial if surgery may be required. For the patient, the new CT scanner is more comfortable, faster, provides better diagnoses, and in many cases reduces the need for an invasive diagnostic procedure.
DIAGNOSIS & STAGING
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LNC team performs a VATS to remove a lung nodule.
Magnetic Resonance Imaging (MRI) creates images of any part of the body without using X-ray radiation. The images are computer generated by recording the appearance of the body’s tissue after the body is placed in a powerful magnet and is exposed to radio frequency signals. MRI can distinguish between normal and abnormal (i.e. malignant) tissues and provides three dimensional, exquisitely detailed images of any anatomic structure and region of the body. An MRI examination takes much longer to complete than a CAT scan and cannot be performed in patients who have any metallic object in their body such as pacemakers, prosthetic joints, some mechanical heart valves and stents.
A Positron Emission Tomography (PET) scan is an imaging test of the entire body that detects and maps sites of increased metabolic activity, such as cancer. While a positive PET scan increases suspicion that a nodule is malignant, it is not proof of malignancy. Other conditions of increased metabolic activity, such as infection and inflammation may cause a lesion to light up on a PET scan. Unlike MRI and CT scans which reveal an abnormal structure a PET scan shows the level of metabolic activity of that structure.
How the test is performed?
A PET scan requires a small amount of radioactive material (tracer). This tracer is given through a vein (IV), usually on the inside of your elbow. It travels through your blood and collects in organs and tissues. The tracer is concentrated in sites of increased metabolic activity such as malignancy and inflammation.