Ep. 603 Biopsy and Ablation Decision-Making in Lung Cancer with Dr. Alan Lee, Dr. Scott Oh, Dr. Rob Suh

·40 min·4 clips

Dr. Scott Oh reveals why ablation confirmation software often fails in the lung due to motion and artifact.

The episode begins with an introduction of the panelists: Dr. Scott Genshaft (UCLA Interventional Radiology), Dr. Scott Oh (USC Interventional Pulmonology), Dr. Rob Suh (UCLA Health Thoracic Interventional Radiology), Dr. Alan Lee (Radiation Oncology at UCLA), and Dr. Kavi Krishnasamy (Interventional Radiologist at UAB). They focus on ablation techniques for lung cancer, starting with the difficulty of confirming ablation zones in the lung due to motion and artifact, contrasting with liver procedures. Dr. Oh expresses skepticism about ablation confirmation software, emphasizing the art gained from experience. Dr. Suh discusses the lack of predictive ablation charts for lung devices, noting that most manufacturers rely on ex vivo data. The panel debates sedation methods, with Dr. Oh preferring moderate sedation for patient control during nerve-sensitive procedures, while others use general anesthesia. They outline modality selection: cryoablation for peripheral lesions near nerves, microwave for central areas, and considerations for heat sink effects based on ventilation and perfusion. Dr. Lee introduces high-dose brachytherapy using iridium-192 for central lesions, detailing the workflow involving catheter placement and collaboration with interventional radiologists. Data from a 2021 study shows 96% local control at two years with low complication rates. The discussion extends to endobronchial brachytherapy for palliative cases. Dr. Lee also describes an MRI-guided linear accelerator that allows patient-controlled breathing for real-time targeting, though it has limitations like patient compliance and device compatibility. Throughout, the panel emphasizes multidisciplinary approaches and technological advancements to improve outcomes for lung cancer patients.

As heard by us

A practical look at lung lesion biopsy, ablation, and targeting under motion and artifact.

Backtable's lung cancer episode keeps its focus on judgment calls: when to biopsy, when to ablate, and how to stay on target when motion and artifact keep getting in the way.

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Why you'd press play

You get the real tradeoffs before the needle goes in.

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