DuBOIS — The Lung Center at Penn Highlands Healthcare has new technology — robotic bronchoscopy — which can assist in an earlier diagnosis of lung cancer, the leading cause of cancer deaths worldwide.
Auris Health’s Monarch Platform, a new robotic system, enables earlier and more accurate diagnosis of small and hard-to-reach nodules in the periphery of the lung, said Dr. Sandeep Bansal, medical director of The Lung Center and Intensive Care Services at Penn Highlands DuBois. The Lung Center was among the first in the United States to have this robotic endoscopy device that detects lung cancer earlier.
“One of the biggest reasons why we can’t conquer lung cancer is that there are no symptoms associated with lung cancer,” said Bansal. “Let’s say if you have a small nodule measuring the size of a quarter, it’s not going to give you any symptoms. So the patient is not going to come to a doctor’s office until it’s too late. When the tumor grows to a certain size, where it starts pressing on the wind pipe or the blood vessels, that’s when they start having symptoms.”
Bansal said there are certain calculators that doctors use to calculate the pretest probability of lung cancer.
“When I see the CAT scan, I see the nodule in the right lung. I can tell the patient that there is a 35 percent probability that this is lung cancer based on certain factors, their age, their smoking history, location of the nodule, so forth,” said Bansal. “But then that 35 percent is not large enough that I should operate on the patient and just take the nodule out because there is a 65 percent chance that it’s not cancer, right?”
When a doctors sees a nodule or spot on the lung, they put them in three categories, he said. One is a low probability of cancer and then there is a high probability of cancer. For a low probability, the doctor can safely watch them; they can tell them that their chances of it being cancer are fairly low and then conduct a follow-up CT scan.
For high probability, which is usually more than 65 percent probability of being cancer, Bansal said if patient can tolerate surgery, they like to take it out surgically.
“Unfortunately, a majority of these nodules will be in that range of 5 percent to 65 percent probability, which is what we call intermediate probability of cancer,” said Bansal. “That’s where the real question is, what do we do next? And lungs are so complex ... you can’t just go in and take a few biopsies. Historically, what you would do is go in with a tiny camera and just guesstimate that this is the location of the nodule and we take a biopsy. But the diagnostic yield with that biopsy was only about 40 percent to 50 percent, this is going back about 10 years.”
The other approach is that a doctor would insert a needle from the outside and try to reach that spot, said Bansal. But since that means kind of piercing the lining of the lung, the chances of lung collapse are very high.
“A lot of these patients have advanced COPD, advanced lung disease, and if you give them lung collapse on top of that, they’re obviously not going to do well,” said Bansal. “To combat that problem navigational bronchoscopy was launched ... which is a platform that allows you to put a tiny GPS light navigation device in the lungs, that’s on the tip of a flexible catheter. You navigate using that catheter, go inside the lung, but the problem with the catheters was that they’re very soft. A lot of times there ... when we put the actual diagnostic tools ... they will not give us the accurate biopsy results or the diagnostic yield,” he said.
That was what Bansal calls the “first generation of navigation bronchoscopy.” Robotic bronchoscopy is the “next generation,” he said.
“It allows you to go inside the lungs using an Xbox type controller,” said Bansal. “You drive using that controller inside the lung in a very, very accurate manner. And when you reach that area where you think the cancer is that you can park that catheter in that location and then you can do biopsies, you can do multiple samples, you can even use therapeutics.”
“It’s still preclinical, it’s still in the research phase, but there are trials ongoing that we are looking at that can burn that tumor using the Laser Fiber,” said Bansal. “That’s looking into future. But at this point in time, this robotic technology has made our diagnostic yield much, much better and much, much more accurate. The procedure itself takes about 30 minutes. It’s done under an anesthesia. The patient goes home on the same day.”
“With a lot of technologies that we do, with this one as well, we are one of the highest volume users in the country, probably top three in the country,” Bansal noted. “And, again it goes with the philosophy that if the technology works, then why wouldn’t you use it? It should be made available to the general public. We are the teaching institution for this technology where physicians will be visiting from different parts of the country to learn this with us.”
There are only 31 health systems that use Monarch, including Penn Highlands DuBois, UPMC Passavant in Pittsburgh and UPMC Hamot in Erie. The next nearest ones are in Farmington Hills, Michigan, and Washington, D.C., according to the Auris Health website.