SOMERS POINT—Imagine a new technology that helps doctors explore deep inside the lungs without performing surgery. Now, thanks to a new adjunct procedure to the standard bronchoscopy—a test where the doctor inserts a bronchoscope (a flexible telescope) into the lungs—pulmonologists can examine distant parts of the lungs with more detail than ever before. All this is done without increasing the invasiveness of the procedure or the risk to the patient.
“It’s important to look beyond the main bronchial tubes where the standard bronchoscopy can ‘see’ because lung cancer isn’t limited to the main airways,” says Bennett Ojserkis, M.D., a pulmonologist with Shore Memorial’s medical staff. “In fact, two-thirds of lung cancers, especially curable ones, are located in the smaller tubes, beyond the reach of the standard instrument.”
Ordinarily, if cancer is suspected, a patient may undergo a standard bronchoscopy to visually inspect abnormal tissue and take samples for a biopsy in the hollow breathing tubes in the lungs where cancers start. However, the quarter inch thickness of a bronchoscope prevents physicians from looking into the smaller branches of the lungs, where many cancers reside.
The new inReach™ system, which works with a standard bronchoscope, is smaller in diameter, longer in length and reaches beyond the large, central bronchial tubes. The new, thinner device is also steerable and equipped with a computer navigation guidance system, just like a GPS in a car, so the doctor can place it precisely into a suspicious area.
Prior to performing a bronchoscopy, the doctor creates a personal three-dimensional map of the patient’s chest using a CT scan and special computer software. This enables him to mark and navigate a virtual “roadmap” of the patient’s lung from a starting point in the main windpipe all the way to the suspicious lesion.
“By viewing these computer images, I’m able to know in advance what I’ll see when I perform the procedure. I call this part the planning stage, because I map out the most direct route to the area of the lung I’m trying to examine. This computer mapping beforehand improves accuracy and reduces the time spent doing even a standard bronchoscopy,” says Dr. Ojserkis.
Just as a GPS navigation system provides drivers directions, the inReach™ system helps guide the physician’s navigation of his biopsy instruments to the outer reaches of the lungs. The thin, steerable biopsy tube has a tiny electronic sensor attached to it. This sensor sends position signals back to a computer as it passes through a harmless electromagnetic field generated by a special mat under the patient’s bed. That way, the “driver” knows where the biopsy tool is at all times on the three-dimensional map of the chest. Once the inReach™ system arrives at the pre-planned “destination,” it is used to take several abnormal tissue samples for laboratory analysis.
Fortunately for patients, this new procedure is less invasive, making them less prone to complications than other diagnostic techniques. Previously, doctors performed either exploratory surgery or a needle biopsy to examine the outer two-thirds of the lungs. Both of these options pose serious risks and can lead to longer healing time.
“A needle biopsy runs a 30 percent chance of collapsing the lung. If a patient already has significantly compromised lungs, we hesitate to do that. Electromagnetic navigation bronchoscopy is a much better choice. The risk of a collapsed lung is only three percent, about the same as a standard bronchoscopy,” says Dr. Ojserkis.
The new procedure adds about 30 minutes to a standard bronchoscopy, and is performed on a same day basis. The patient is fully sedated and does not feel any pain during the procedure. Side effects are usually mild and include sore throat, cough or hoarseness.
“I’m very excited to work with this emerging, sophisticated technology. We’re able to reach areas in the lungs without surgery and do things you can’t do with a fine needle biopsy. Overall, we’re able to go beyond anywhere we’ve been able to go before, and that benefits everyone,” says Dr. Ojserkis.