Technology Guides Better Lung Biopsy, 3-D Imaging Reduces Failures
August 23, 2013
Augusta, GA - Wayne Bissell had just left his doctor’s office a couple of hours earlier, after a CT scan, when they called to see if he and his wife could come back before the office closed.
“You know that’s not going to be exciting news,” said Bissell, 50, of Evans. The results were shocking.
“You’ve got a spot on both of your lungs presenting as cancer,” Bissell was told. “And it didn’t start there,” meaning they were likely metastases from a primary tumor elsewhere.
But Bissell opted to get a lung biopsy at Doctors Hospital using new technology that helped him avoid surgery and that found the masses were benign. As he was coming out of the anesthesia after the procedure, “I could tell by my wife’s smile it was good news,” Bissell said.
Often when a patient has a spot or shadow on a lung scan it isn’t clear what it is, said pulmonologist Carmel Joseph, who did Bissell’s biopsy at Doctors.
“Probably 80 percent of the time we cannot tell just by looking at the spot whether it is a malignancy or not,” he said.
Physicians use the patient’s risk factors – whether they were smokers or had any family history of cancer – to help determine the urgency of dealing with it. If the patient is healthy – like Bissell, a nonsmoker with no family history who stays active – and the spot is small, they might be told to get a scan in a few months to see if it has changed, Joseph said.
Under the old system, “we’re basically hedging that it won’t change and, if it changes in size, we then send a surgeon to take it out,” he said. “Surgeons were cutting away, in the ’80s and ’90s. And a lot of them were benign. You just lost a third of your left lung for a benign condition.”
In fact, Bissell might have been facing a similar situation because the spot of greatest interest was very deep in the left lobe of his lung just above his diaphragm. Even if he reaches it, the odds of hitting the exact right spot in that area to get a good biopsy using X-ray technology are about 30 percent, Joseph said.
“We might be in front or behind it because it is 2-dimensional (imaging),” he said. “We think we’re in it but we’re actually two millimeters in front of it.” Where Bissell’s spot sat could only be reached through surgery, Joseph said.
But thanks to a technique called Electromagnetic Navigation Bronchoscopy, Joseph can be guided down to a tricky spot and hit a 3-dimensional target. A lung CT scan is loaded into a program that then builds a 3-D model of Bissell’s lungs, allowing Joseph to do a virtual bronchoscopy, guiding to where the most suspicious spot lies.
“It’s slightly irregular,” Joseph said, as he looked at a fuzzy white blob on Bissell’s scan. “And it’s a good size” at 23 millimeters in diameter. After creating a cube target on the spot, working through the program called SuperDimension, he is ready for the next step.
“Now if we do a pathway, this is the cool part,” he said, as suddenly in the virtual screen there is a purplish branching path down through the lungs. “It’s given me a pathway to the target.” The pathway is in 3-D and can be pulled out as an image to study by itself from all sides. Doing that reveals a further complication in Bissell’s case – getting to the exact spot requires going into a narrow shaft off the airway.
“I’ve got to make this turn to get into it,” Joseph said. “All you have to do is miss it by a few millimeters and you’ve got a negative biopsy. We just changed the whole game with this.” Joseph could then see the pathway and the imagery as a guide as he went in to do the actual biopsy.
Bissell was able to go home with his negative result a couple of hours later, although he wanted to go to work. And he can smile about his cancer scare and the end result now.
“It was good news, absolutely,” he said.