Called SuperDimension Bronchus, this new diagnostic tool is described by its Israeli manufacturer as a "global positioning system" for the lungs. The device uses electromagnetic and imaging technology and a unique steerable catheter to probe tiny vessels. This electromagnetic-guided system provides doctors with 3-D images as the probe makes its way through the lung's narrow passageways.Prior to this system, physicians would only be able to use a conventional probe effectively in about 30 percent of the lung, according to information from Methodist Medical Center, one of 25 medical facilities in the country using the technology. With the new device, which costs about $100,000, physicians can reach areas in virtually every part of the lung. "This is a tremendous improvement over traditional bronchoscopy," said Dr. Pat Whitten of Peoria Pulmonary Associates.
The pulmonologist believes it will become a key tool in the minimally-invasive diagnosis of lung disease, including lung cancer, emphysema and asthma. He hopes the new device will someday help reduce the growing incidence of lung cancer deaths.
"Heart disease has declined by 50 percent in the past 10 or 15 years, but lung disease has increased 220 percent in that same time frame," Whitten said.
"Roughly six out of 10 patients with lung cancer will die within a year of diagnosis. The earlier we diagnose the disease, the better chance of a cure. And to detect cancer earlier is going to take better diagnostic tools."
Each year an estimated 155,000 Americans die of lung cancer, the leading cause of cancer death in the United States. With the use of CT scans, an X-ray procedure, spots smaller than 2 centimeters are being found deep in the lungs.
"We can find these spots with CT scans, but we don't know if they are benign or malignant," Whitten said. "We still need to diagnose them.
In the 1960s and 1970s, these spots and part of the lung were routinely cut out with surgery. Many of these spots turned out to be benign."
While providing effective results in the main areas of the lung, bronchoscopy is performed somewhat blindly in the peripheral areas where most lesions are located.
The bronchoscope can't proceed past the central airway. To reach targets in the peripheral areas, the pulmonologist must insert diagnostic tools through the bronchoscope's working channel. Not being steerable, conventional tools are difficult to maneuver in tight places. The probe may not be able to reach the spot in order to take a biopsy.
And with conventional bronchoscopy, pulmonologists use fluoroscopy to navigate deep into the lungs. With fluoroscopy, detecting nodules smaller than 2 centimeters is very difficult, which makes getting tissue for a biopsy from a very small spot somewhat hit or miss.
"With peripheral lung nodules less than 2 centimeters, we have a 50 percent success rate in getting a diagnosis with the traditional bronchoscopy system," Whitten said. "That's a terrible return."
The alternative is to perform a needle biopsy, which involves sticking a needle through the chest wall to the spot in the lung in order to obtain the tissue biopsy. While the rate of diagnosis is about 95 percent with needle biopsy, the procedure is more invasive and presents a greater risk of complications than bronchoscopy.
"When you do a needle biopsy, you collapse the lung a good part of the time, maybe 80 percent of the time," Whitten said. "In about 15 percent of these collapsed lung cases, the patient will need a chest tube and stay in the hospital a couple of days.
"Many elderly patients and those with coexisting lung disease may not survive a collapsed lung. So the risks are much greater with a needle biopsy."
SuperDimension Bronchus is a less traumatic procedure to the patient with about the same results as a needle biopsy.
"With a needle biopsy, you are only hitting one spot," the pulmonologist said. "With this new bronchoscopy, we are looking throughout the lungs. It's a total exam. We may discover more abnormalities, including more spots."
SuperDimension Bronchoscopy is basically a traditional bronchoscopy with extra guidance tools, Whitten explained. He has performed 10 of the 15 local procedures using the new device at Methodist hospital. The actual procedure takes about 40 minutes with the patient partially asleep. The patient typically goes home following the procedure.
"I have had one non-diagnosis with this new system," Whitten said. "That's a 90 percent accuracy rate. It's very early, but that's a much better success rate than traditional bronchoscopy. And it doesn't have as great of risk as a needle biopsy."