Using technology to find lung cancer earlier

Each year, more people in the U.S. die from lung cancer than any other type of cancer. Lung cancer is typically diagnosed in later stages when it has already spread. This often happens because the cancer is not detected until symptoms appear or because traditional diagnostic methods cannot reach small nodules — a mass of rounded or irregular shape — deep in the lungs.

Sharp Grossmont Hospital uses cutting-edge technology that makes it possible to diagnose and treat lung cancer earlier, greatly improving chances of survival. The hospital is the first health care provider in San Diego County to offer robotic-assisted bronchoscopy.

Improving lung cancer diagnosis
The U.S. Preventive Services Task Force recommends annual lung cancer screenings for people who have a history of heavy smoking, currently smoke or have quit smoking within the past 15 years and are between the ages of 55 and 80 years old. If a suspicious nodule is detected during a CT scan, that patient may be referred for robotic-assisted bronchoscopy.

Robotic-assisted bronchoscopy allows doctors to access and take samples of suspicious nodules in hard-to-reach areas of the lungs in order to determine if they are cancerous. The Monarch™ Platform at Sharp Grossmont provides greater control and precision along with 3D vision that enables doctors to reach parts of the lungs that are not accessible with conventional diagnostic methods.

The procedure is performed by a pulmonologist with the support of a cardiothoracic surgeon, nursing staff and a respiratory therapist. Typically, there is also a pathology technician in the room who prepares the specimen for a pathologist to read. Here's how it works:

1. The patient's CT scan is uploaded into the Monarch™ Platform software, allowing the doctor to see a 3D image of the patient's lungs and reach the airway where the nodule is located.

2. A bronchoscope — a thin, flexible tube — is inserted through the nose or mouth and navigated down the airway to the nodule using a hand-held controller. The entire time, a high-resolution 3D image of the lung is visible on a screen.

3. Once the bronchoscope reaches the nodule, the doctor takes a biopsy to be processed by a pathologist, who later determines if the nodule is malignant (cancerous).

"This advanced procedure can be used as one more tool to provide an early diagnosis in cases where we would normally have waited before taking any action," explains Dr. Kaveh Bagheri, a pulmonologist affiliated with Sharp Grossmont Hospital. "Because the robotic-assisted bronchoscope has the ability to travel deeper into the lung and precisely guide a biopsy instrument with continuous vision to even the most difficult-to-reach nodules, the technology offers the potential to diagnose lung cancer at an earlier stage."

Taking treatment to new heights
If a nodule is found to be malignant during the procedure, doctors at Sharp Grossmont Hospital now have the option of moving the portable unit into the operating room to "tag" it — or mark it with dye — before removal, making surgery easier. This is important when a tumor is deep in the lungs; having the ability to tag the nodule helps the surgeon find and successfully remove it.

"Sharp Grossmont Hospital is truly at the forefront of lung and thoracic care," says cardiothoracic surgeon Dr. Ara Klijian, chair of the cardiothoracic committee at Sharp Grossmont and director of the Minimally Invasive Cardiothoracic Institute of San Diego. "We have an amazing group of dedicated pulmonologists as well as a full cardiothoracic surgical program that includes the only center on the West Coast, and one of the few in the U.S. that offers awake video-assisted thoracic surgery, or AVATS."

AVATS is a minimally invasive surgical technique used for a variety of procedures in the chest, including lung nodule removal. While traditional surgery requires patients to undergo general anesthesia, AVATS uses a local anesthetic and sedation, minimizing the risk for vulnerable patients and resulting in a shorter hospital stay and faster recovery time.

Dr. Bagheri and Dr. Klijian are enthusiastic about the advanced care they can provide with the cutting-edge procedures available at Sharp Grossmont. With emerging technologies such as robotic-assisted bronchoscopy and AVATS, they can perform complicated procedures less invasively, resulting in improved outcomes for patients.

For the news media: To talk with Dr. Bagheri and Dr. Klijian about robotic bronchoscopy for an upcoming story, contact Erica Carlson, senior public relations specialist, at erica.carlson@sharp.com.