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Alan Moy, MD Alan Moy, MD Pulmonary Associates of Pulmonary Associates of Iowa City Iowa City Mercy Hospital of Iowa Mercy Hospital of Iowa City City Electromagnetic Navigation Electromagnetic Navigation Bronchoscopy Bronchoscopy A New Treatment for Patients with Peripheral A New Treatment for Patients with Peripheral Lung Lesions Lung Lesions

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Page 1: Alan Moy, MD Pulmonary Associates of Iowa City Mercy Hospital of Iowa City Electromagnetic Navigation Bronchoscopy A New Treatment for Patients with Peripheral

Alan Moy, MDAlan Moy, MDPulmonary Associates of Iowa Pulmonary Associates of Iowa

CityCityMercy Hospital of Iowa CityMercy Hospital of Iowa City

Electromagnetic Navigation Electromagnetic Navigation BronchoscopyBronchoscopy

A New Treatment for Patients with Peripheral Lung A New Treatment for Patients with Peripheral Lung LesionsLesions

Page 2: Alan Moy, MD Pulmonary Associates of Iowa City Mercy Hospital of Iowa City Electromagnetic Navigation Bronchoscopy A New Treatment for Patients with Peripheral

Lung Cancer: An Epidemic?Lung Cancer: An Epidemic?

In U.S.: #1 cause cancer-related death1

#2 death behind heart disease1

More than breast, prostate, colon and pancreatic cancers combined1

87% of lung cancer deaths related to tobacco2

Sources: 1. Jemal A, et al., 20072. American Cancer Society, 2006

Page 3: Alan Moy, MD Pulmonary Associates of Iowa City Mercy Hospital of Iowa City Electromagnetic Navigation Bronchoscopy A New Treatment for Patients with Peripheral

Lung Cancer: A Growing Lung Cancer: A Growing ProblemProblem

2007 estimates for US: > 213,000 new cases1

> 160,000 deaths1

45 million smokers in US

Lung cancer risk:2

20 times higher for male smokers 12 times higher for female smokers

The population is aging and the incidence of lung cancer will grow3

Sources: 1. Jemal A, et al., 20072. Ries L et al., 20033. American Cancer Society, Surveillance Research, 2006

Page 4: Alan Moy, MD Pulmonary Associates of Iowa City Mercy Hospital of Iowa City Electromagnetic Navigation Bronchoscopy A New Treatment for Patients with Peripheral

Lung Cancer: Poor Lung Cancer: Poor PrognosisPrognosis

>75% of new cases have late-stage cancer (Stage III or IV)1

5-year survival rate

is only 15%2

65-70% Stage III or IV

Only 15%will survive

5 years

Sources: 1. Dubey S et al., 20062. Ries L et al., 2003

Page 5: Alan Moy, MD Pulmonary Associates of Iowa City Mercy Hospital of Iowa City Electromagnetic Navigation Bronchoscopy A New Treatment for Patients with Peripheral

Early Diagnosis Offers HopeEarly Diagnosis Offers Hope

If diagnosed at Stage III or IV, 15% survival rate at 5 yrs1

If diagnosed at Stage I, 88% survival rate at 10 yrs1

92% survival rate if immediate removal of lesion1

Only 16% of lung cancer patients are diagnosed at an early, localized stage.2

0

20

40

60

80

100

15%

88%92%

SURVIVAL RATES

Source: 1. Intl Early Lung Cancer Action Program Investigators, 20062. Reis L, et al, 2003.

Page 6: Alan Moy, MD Pulmonary Associates of Iowa City Mercy Hospital of Iowa City Electromagnetic Navigation Bronchoscopy A New Treatment for Patients with Peripheral

Early Stage AdvantageEarly Stage Advantage

STAGE I OR II LESION STAGE III OR IV LESION

SMALLER

DISTAL LOCATION

DISCREET

EASIER TO TREAT

SURVIVAL RATE = 88% @ 10 YEARS

LARGER

PROXIMAL LOCATION

ORGANIZED & WIDESPREAD

TOO LATE FOR EFFECTIVE TREATMENT

LIFE EXPECTANCY +/- 6 MONTHS

Source: 1. Intl Early Lung Cancer Action Program Investigators, 20062. American Cancer Society, Surveillance Research, 2006

Page 7: Alan Moy, MD Pulmonary Associates of Iowa City Mercy Hospital of Iowa City Electromagnetic Navigation Bronchoscopy A New Treatment for Patients with Peripheral

Failure of BronchoscopyFailure of Bronchoscopy

500,000 bronchoscopies performed annually in the US1

65% of bronchoscopies fail to reach peripheral lesions2

Failure of bronchoscopy leads to more invasive diagnostic procedures

Source:1. Ernst et al., 20032. Schwarz Y et al., 2006

Page 8: Alan Moy, MD Pulmonary Associates of Iowa City Mercy Hospital of Iowa City Electromagnetic Navigation Bronchoscopy A New Treatment for Patients with Peripheral

Current Approaches to Current Approaches to DiagnosisDiagnosis

MethodMethod LimitationsLimitationsWatchful Waiting Watchful Waiting Malignant CANCER can Malignant CANCER can

ADVANCE stageADVANCE stage

Sputum, CXR, CT, PETSputum, CXR, CT, PET No tissue collectionNo tissue collection

BronchoscopyBronchoscopy Limited reach and Limited reach and low diagnostic yieldlow diagnostic yield

Transthoracic Needle Transthoracic Needle Aspiration (TTNA)Aspiration (TTNA)

PneumothoraxPneumothoraxNot all patients are candidatesNot all patients are candidates

SurgerySurgery Non-therapeutic thoracotomyNon-therapeutic thoracotomyHighly invasiveHighly invasive

Not all patients are candidatesNot all patients are candidates

INVASIVE

Page 9: Alan Moy, MD Pulmonary Associates of Iowa City Mercy Hospital of Iowa City Electromagnetic Navigation Bronchoscopy A New Treatment for Patients with Peripheral

Total Bronchial Access & Total Bronchial Access & NavigationNavigation

Expanding the boundaries of patient care

An electromagnetic navigation system that meets the unmet medical need for a minimally invasive procedure

Improved diagnostic yield of peripheral lung lesions and mediastinal lymph nodes1

Source: 1. Schwarz et al., 2006

Page 10: Alan Moy, MD Pulmonary Associates of Iowa City Mercy Hospital of Iowa City Electromagnetic Navigation Bronchoscopy A New Treatment for Patients with Peripheral

inReach™ ProcessinReach™ Process

DICOM CD

PLANNING: Preparing for the

Procedure and Learning the Patient’s Anatomy

NAVIGATION : Tx Scope (2.8mm)

Bx/Tx

CT Scan :

Page 11: Alan Moy, MD Pulmonary Associates of Iowa City Mercy Hospital of Iowa City Electromagnetic Navigation Bronchoscopy A New Treatment for Patients with Peripheral

inReach™ System: Navigation inReach™ System: Navigation PhasePhase

Position steerable navigation catheter near the target

Lock guide catheter in place and remove steerable navigation catheter

Insert endobronchial instruments through guide catheter

Use instruments to remove tissue samples

Page 12: Alan Moy, MD Pulmonary Associates of Iowa City Mercy Hospital of Iowa City Electromagnetic Navigation Bronchoscopy A New Treatment for Patients with Peripheral

inReach™ inReach™ System ComponentsComponents

Guide Catheter

Steerable Navigation Catheter

Page 13: Alan Moy, MD Pulmonary Associates of Iowa City Mercy Hospital of Iowa City Electromagnetic Navigation Bronchoscopy A New Treatment for Patients with Peripheral

inReach™ System inReach™ System ComponentsComponents

Location Sensor

inReach Planning Software

PatientSensors

Page 14: Alan Moy, MD Pulmonary Associates of Iowa City Mercy Hospital of Iowa City Electromagnetic Navigation Bronchoscopy A New Treatment for Patients with Peripheral

inReach™ System inReach™ System AdvantagesAdvantages

Extended Reach

Access to peripheral lesions

Access to central lung lesions and mediastinal lymph nodes

Compatible with most endobronchial tools

Minimally invasive

Page 15: Alan Moy, MD Pulmonary Associates of Iowa City Mercy Hospital of Iowa City Electromagnetic Navigation Bronchoscopy A New Treatment for Patients with Peripheral

inReach™ System inReach™ System AdvantagesAdvantages

Greater Clarity

Diagnostic yield of 69-74%1,2

Target peripheral lesions

Preview and determine path prior to procedure

Navigate and steer through multiple branches of the bronchial tree

Sources:1. Becker et al., 20052. Gildea et al., 2006

Page 16: Alan Moy, MD Pulmonary Associates of Iowa City Mercy Hospital of Iowa City Electromagnetic Navigation Bronchoscopy A New Treatment for Patients with Peripheral

inReach™ System inReach™ System AdvantagesAdvantages

Multi-Use and Multi-

Specialty inReach advantages cross

several specialties

PULMONOLOGISTS

THORACICSURGEONS

RADIATIONONCOLOGISTS

Page 17: Alan Moy, MD Pulmonary Associates of Iowa City Mercy Hospital of Iowa City Electromagnetic Navigation Bronchoscopy A New Treatment for Patients with Peripheral

inReach™ System Clinical inReach™ System Clinical ResultsResults

Effective

Successful diagnosis of peripheral lesions in 69-74% of inReach cases1

Even higher success rates for lymph nodes

1. Gildea et al., 2006

Page 18: Alan Moy, MD Pulmonary Associates of Iowa City Mercy Hospital of Iowa City Electromagnetic Navigation Bronchoscopy A New Treatment for Patients with Peripheral

inReach™ System Clinical inReach™ System Clinical ResultsResults

Safe Pneumothorax rate of 2.3%

(similar to standard bronchoscopy)1

Published > 1 dozen published papers

Used in Multiple Centers

> 2000 patient cases worldwide

1. Eberhardt et al., 2007

Page 19: Alan Moy, MD Pulmonary Associates of Iowa City Mercy Hospital of Iowa City Electromagnetic Navigation Bronchoscopy A New Treatment for Patients with Peripheral

Why the inReach™ System?Why the inReach™ System?

For Patients

Minimally invasive

Enables earlier diagnosis and earlier treatment decisions

Potential for lower complication rates

Page 20: Alan Moy, MD Pulmonary Associates of Iowa City Mercy Hospital of Iowa City Electromagnetic Navigation Bronchoscopy A New Treatment for Patients with Peripheral

Why the inReach™ System?Why the inReach™ System?

For Physicians

Expanded options for accessing lung lesions

Improved steering through multiple branches of bronchial tree

Potential for planning multiple procedures

Ability to diagnose and stage distal lesions

Enhanced decision making for diagnostic and treatment options

Improved patient care with minimally invasive procedure

Faster route to diagnosis and treatment

Page 21: Alan Moy, MD Pulmonary Associates of Iowa City Mercy Hospital of Iowa City Electromagnetic Navigation Bronchoscopy A New Treatment for Patients with Peripheral

Why the inReach™ System?Why the inReach™ System?

For Hospitals

Improved patient care

May reduce complication rates that can occur with more invasive options

Retained patients for treatment by:

Radiation oncologists Thoracic surgeons

Page 22: Alan Moy, MD Pulmonary Associates of Iowa City Mercy Hospital of Iowa City Electromagnetic Navigation Bronchoscopy A New Treatment for Patients with Peripheral

Closing CommentsClosing Comments

Alan Moy, MDAlan Moy, MD

Mercy Hospital Iowa CityMercy Hospital Iowa City

Pulmonary Associates of Iowa Pulmonary Associates of Iowa CityCity

319-887-2873319-887-2873