Bronchoscopy & Lung Nodule Biopsy | Fox Chase Cancer Center


When a patient gets a lung nodule, the
biggest concern is that “Is the nodule cancerous?” Many of these long nodules
turn out to be nothing, but you can’t ignore them. You can’t sit on them. You
can’t wait. For those that have lung nodules that end up being a cancer, we
need to move fairly quickly. Fox Chase Cancer Center has a comprehensive lung nodule program, where results can be fast-tracked to meet specialists who
diagnose and specialists who treat lung nodules. When a patient comes in with a lung nodule, they can be seen by a number of different people. They could be seen
first by a thoracic surgeon, they could be seen by a pulmonologist, or they could be seen by one of our nurse practitioners. They could have a repeat
CAT scan in a short order, to see if the nodule is changing in size or shape.
They could have a PET scan to see if it’s metabolically active, or if it’s
suspicious enough, we’ll proceed straight to a biopsy so that we don’t delay their
diagnosis. You have a couple of options in terms of how you would approach them to do a biopsy. One way is to do a bronchoscopy, which involves going down
your airways with a small flexible scope and trying to biopsy a nodule from
within. The other option is for a radiologist to do a needle biopsy from
outside the lung. These traditional methods, though, may not be able to reach nodules if they’re further out in the branches of the lung. That’s why our
pulmonologists have this advanced technology to get to these hard-to-reach
nodules. So here at Fox Chase, we’re one of the first centers in the nation to have
the Monarch Robotic Bronchoscopy Platform. This allows us to get out into
the periphery of the lung with increased dexterity and increased visualization to get a more targeted biopsy specimen. What it means to me is the next evolution in how
we approach these lung nodules. You’re taking a very small, very sophisticated
robotic arm and you’re navigating through the airways with direct
visualization. We’ve done hundreds of these cases over the past couple of
years and we’re doing it in a high-volume center with a team that has been drilled
on these procedures. That’s where that consistency comes from and that’s where
we get great success. Instead of you having to hold the scope with your hand,
you’re now using a remote controller to drive a scope down a patient’s airways. The first part of how the system works, starts with a very
simple CAT scan. We can take those images and we can sync them to the robotic
platform, so now we’ve got a road map. Now we’ve got basically a turn-by-turn GPS
for the lung, so just with one procedure you’re much more likely to get an
accurate answer the first time. We can reach nodules that we have not been able
to reach before far more deep out in the lung, close to the edge of the lung,
now. In order to decide the best course of treatment, the team needs a tissue
sample large enough to determine the cancer’s genetic makeup.
Being able to directly see the nodule gives our physicians the assurance that
they’re collecting a large enough targeted sample for testing. We’ll be
able to make these cases shorter and make them faster with less anesthesia time for the patient, and less recovery time. We find the nodule. We biopsy it. We look at
all of the lymph nodes throughout both lungs, so the person has a diagnosis and
a stage for their cancer, and then they can meet quickly thereafter to decide
what to do next. Having this technology is so important for these lung patients,
but it’s the strong Fox Chase Interventional Pulmonology team, as well,
that makes all the difference. It’s our nurses, our respiratory techs, and our bronch techs who are helping with all these instruments and all that team
effort is why we have great success. At Fox Chase, the landscape of Interventional Pulmonology is changing every day and these technologies – they build on
previous generations so that we’re able to offer our patients cutting-edge
modalities. When I think about Fox Chase, I think about the years of experience in
the departments around me. I think about the reproducibility of our biopsy
procedures; the level of training of our cytologists, respiratory therapists,
endoscopy nurses, and that gives us great insight. We use the experience of all of
our peers to provide the best recommendation and the best treatment
plan for patients.