Resolving The Mystery of Puzzling Pulmonary Nodules

Lung Nodule Program Overview

Daya Upadhyay, MDAssociate Professor of Clinical Medicine, UCSF

Medical Director, Lung Nodule ProgramDirector, Translational Research in MedicinePulmonary, Critical Care & Sleep Medicine

University of California San Francisco, Fresno

Disclosures

Disclosures : None

CRMC Hospital

California Cancer Center

UCSF Fresno

Lung Nodule Program

Patient CareLung Nodule Clinic

Smoking Cessation

Careful speedy triage team

Diagnostic Radiology

PathologyThoracic Surgery

Social worker

Multi-disciplinary Team Approach

Interventional Radiology

Medical OncologyRadiation Oncology

Interventional Bronchoscopy

Nodule RegistryResearch Training

Endoscopy Team

Pulmonologists

Diagnostic TrainingResearchTherapeutic

Multidisciplinary Lung Nodule Program

No

of P

atie

nts

seen

eac

h ye

ar

Growth of Lung Nodule Program

0

400

800

1200

1600

51

439

786904 953

1230

1497

Associate DeanDr. Peterson

2009

72%

28%

OtherLung Cancer

Lung Nodule Program

Kathryn Bilello, MDProgram Director, PCCMFellowship UCSF‐Fresno;Clinical Professor , UCSF

Kathy Norkunas, RNCatrina Asanuma, RNKaren & Roxanna

Michael Peterson, MDProfessor of Medicine, UCSF, Chair of Medicine UCSF‐Fresno, Vice‐Chair of Medicine, UCSFInterim Associate Dean, UCSF

Karl Van Gundy, MDChief, Pulmonary, Critical Care &Sleep, UCSF‐Fresno; Clinical Professor , UCSF

Interventional BronchoscopyCoccidioidomycosis

Education & Training

Daya Upadhyay, MDDirector, Lung Nodule Program Director, Translational ResearchAssociate Professor, UCSF

Translational ResearchResearch Tissue Bank

Clinical Research

Thoracic Surgery Navigators, Coordinators

Pravachan Hegde, MDInterventional PulmonologistAssistant Professor, PCCMUCSF- Fresno

Fellows & Trainees

Binh Trinh, MD, PhDAssistant Professor, SurgeryMinimally Invasive Thoracic Surgery, UCSF‐Fresno

Patient CareLargest Lung Nodule Program in the US

UCSFCRMCCCC

Members of Lung Nodule Program and Thoracic Tumor Board: Medical Oncologist, Radiation Oncologist, Surgeons, Interventional Radiology, Endoscopy, Pathology, Social Worker, Compass Care

Multi-disciplinary Team

Expedite Triage System

Triage

Referral

CT Review

MD Visit Multidisciplinary Team discussion

Diagnostic Bx

Referral Surgery / Oncology

< 10 days

Early Diagnosis

Lung Nodules: 50% Cancer , 50% Valley FeverBlood TestLung Nodule Biopsy is required

Bronchoscopic Biopsy

Endoscopy

BronchoscopyFiberoptic Bronchoscope Rigid Bronchoscope

Interventional BronchoscopyState of Art Interventional Bronchoscopy Suite

1. Advanced diagnostic flexible bronchoscopy 2. Endobronchial ultrasound (EBUS)-guided

biopsy3. EBUS guided staging for lung cancer4. Trans Bronchial Needle Biopsy 5. Electromagnetic navigational bronchoscopy 6. Airway applications of balloon bronchoplasty7. Rigid bronchoscopy 8. Medical pleuroscopy 9. Pleural biopsy and pleurodesis

Diagnostic

Interventional BronchoscopyState of Art Interventional Bronchoscopy Suit

1. Management of benign and malignant airway and pleural diseases

2. Airway applications of balloon bronchoplasty

3. Argon plasma coagulation 4. Endobronchial brachytherapy 5. Cryotherapy 6. Electrocautery 7. Foreign body retrieval 8. Metallic and silicone stent placement 9. Nd-Yag laser

1. Management of Pleural Disease

2. Chest tube placement3. Transtracheal oxygen

catheter 4. Pleural catheter placement 5. Percutaneous dilational

tracheostomy

Therapeutic Procedures

Endobronchial Ultrasound-guided BiopsyEsophageal Ultrasound-guided Biopsy

For Mass or Mediastinal Lymphnode Biopsy For Diagnosis and Cancer Staging

Electro-Magnetic navigational Bronchoscopy

EBUS for Lung Cancer Staging

Endo Bronchial Stent Placement Intrabronchial Valve

Endobronchial brachytherapy

Foreign Body Removal

BronchoCath

Bronchial Blocker

Pleuroscopy

Training Fellows

Multi-disciplinary Tumor Board

Multi-disciplinary Tumor Board

Team of 6 Medical Oncologists with Dedicated expert in Lung CancerInfusion Center

Imaging facility

Dedicated Thoracic Surgeon who performs minimally invasive thoracic surgeries

Expert Radiation Oncologist

Expert Medical Oncologist

Thoracic Surgery

Binh Trinh, MD, PhDAssistant Professor, SurgeryMinimally Invasive Thoracic Surgery, UCSF‐Fresno

Dr. William Silveira

New Members

Dr. Omid Tehrani

Clinical Research

Research

Translational Research

Dr. Paul Mills Dr. Peterson

Epidemiology Research

Lung Nodule Research Database

Coccidioidomycosis

Dr. Upadhyay

Lung Cancer, MutationsMolecular Markers

Research Biorepository

...and many more……..

Improve quality of our patient careDevelopment of newer diagnostic and

treatment strategiesTraining new generation Save lives

Future Vision

Thank You