MORGANTOWN, W.Va. — Lung cancer is the leading cause of cancer deaths worldwide, according to the American Cancer Society, with more people dying each year of lung cancer than of colon, breast, and prostate cancers combined. In the United States, West Virginia ranks second in lung cancer deaths.
Diagnosis is usually delayed due to low uptake of screening programs and access to accurate and safe biopsy techniques. Lung biopsies can be tricky, given their structure and function, but advanced imaging technology at the WVU Heart and Vascular Institute (HVI) isimproving their accuracy for WVU Cancer Institute patients.
“With the marriage between robotic bronchoscopy and advanced imaging technology, we are moving beyond traditional methods to offer safe, accurate, and timely diagnosis and treatment, which in turn improve patient outcomes,” Saiesh Voppuru, M.D., a thoracic surgeon in the HVI’s Department of Thoracic and Esophageal Surgery, said.
Lung cancer first appears as a small nodule, often referred to by patients as a “spot on the lung.” Nodules can be attributed to severalcauses other than cancer, including scarring or past infections. However, many lung nodules do end up being cancerous, and as with any cancer, early diagnosis is ideal. Time is of the essence; the sooner treatment happens, the better the outcome.
Because of the size and shape of the lungs, many nodules end up in the organs’ outer (peripheral) regions. This makes it harder for doctors to reach the nodule with a bronchoscope, a long, thin tube inserted through the patient’s trachea (windpipe). In these cases, cancerous nodules are often diagnosed through a needle biopsy that is guided through the chest wall and to the nodule by computerized tomography (CT) imaging, which is the traditional method but could be associated with complications like lung collapse.
Robotic bronchoscopy helps reach the peripheral nodules while mitigating the risk of complications. However, this is not without challenges.
“Lung nodules appear to shift, depending on the volume of air inside the lung. We call that a CT-to-body divergence,” Dr. Voppuru said. “CT-to-body divergence makes it harder for us to navigate to the nodule’s exact location. The doctor is basically looking at a moving target, and the bronchoscope’s catheter can miss the nodule based on its movement.”
A successful lung biopsy requires tremendous precision and control. Cone beam CT is an advanced imaging technology that allows refined, real-time visualization of nodules.
“Deep lung biopsies can now be performed without long needles passing through the chest wall and peripheral nodules that would otherwise be inaccessible with a traditional bronchoscopy can be targeted, thanks to the pairing of cone beam CT with robotic bronchoscopy,” Voppuru, who pioneered this technique at HVI, explained.
“Cone beam CT is almost like a regular CT scan, but there is a lower dose of radiation, and it can be done right in the OR, which is a big benefit. The unit spins around the patient as they are lying on the table. In real time, we can navigate right to that nodule with the robotic bronchoscope and overcome that divergence to boost accuracy.”
The difficulty of targeting a lung nodule’s exact location through traditional methods sometimesresults in biopsies that fail to properly yield a definitive diagnosis, requiring patients to undergo the procedure a second time, potentially delaying treatment for weeks while the nodule continues to grow.
delicate procedures such as lung nodule biopsy
via bronchoscopy, as shown.
Voppuru described the case of one patient with a particularly hard to reach lung nodule who had struggled to get a diagnosis for a few years prior to seeking treatment at HVI and the WVU Cancer Institute.
“Meanwhile, this nodule had been growing,” he said. “I was able to get the diagnosis for her and then she recently got her surgery. That’s the power of this technology that we can harness. This is one of the many successful such procedures accomplished at HVI so far.”
Voppuru also noted HVI surgeons are also using cone beam CT for other advancedapplications that once required separate procedures spaced weeks apart.
“We call this a single anesthesia event. This is where we go in, navigate to the nodule, mark it with fluorescent dyes, and resect in the same setting. In a similar pathway, carefully selected cases where we have a high suspicion of cancer based on prior testing and imaging, we can perform the biopsy, onsite pathology can confirm cancer quickly, and we can perform major lung surgery in the same setting. This only requires the patient to undergo anesthesia one time, instead of once for a biopsy and again for surgery,” Voppuru said.
“And soon, we’ll pair this platform with advanced technologies, such as pulse electric field ablation, to treat locally advanced lung cancer in patients who are not candidates for surgery or maybe have metastatic cancers that spread to the lungs from other areas.”
For more information about the WVU Heart and Vascular Institute, visit WVUMedicine.org/Heart. For more information about the WVU Cancer Institute, visit WVUMedicine.Cancer.
