Accurate lung cancer diagnosis requires a biopsy, but sampling small nodules using regular technology is like trying to find a quarter in a swimming pool, said Dr. Otis Rickman.
"You jump in the water, and if you don't have goggles or gear, you can't see the quarter — you're just groping around blindly," said Rickman, director of interventional pulmonology at Vanderbilt University Medical Center. "Fortunately, there's somebody who's pioneering the way for this type of lung biopsy, and he happens to be right here in Chattanooga."
Dr. Krish Bhadra, an interventional pulmonologist with CHI Memorial's Standefer Lung Center, is one of two or three physicians in the nation now using cone beam CT bronchoscopy, Rickman said. Memorial was the first site in the world to use the technology, which lets a doctor guide a scope through patients' mouths into the lungs and accurately grab pieces of suspicious tissue using real-time imaging.
"A limitation in the past is being able to get to these, because you have all this real estate in the lungs that you're trying to navigate," Rickman said.
He and his colleague, Dr. Fabien Maldonado, director of Vanderbilt's interventional pulmonary fellowship program, visited Memorial this week to learn from Bhadra, who has been practicing with the equipment for about 4 months. Their own hospital will introduce cone beam CT bronchoscopy in the coming months.
"This technology is amazing," said Rickman, as he watched a procedure on Tuesday afternoon. "It's bringing little nodules that we would never have been able to biopsy within reach."
Rickman said physicians without the cone beam CT must wait until the worrisome spot grows big enough to biopsy using standard methods or attempt the sample knowing that it may not provide a diagnosis. There is also a smaller risk for complications with the bronchoscopy, which is typically an outpatient procedure, over more invasive needle biopsies inserted from outside the lung.
Most patients with 8 millimeter lung lesions — the size of the nodule in question — wait months between when the spot is first detected and learning whether or not it's cancerous. The spot in Tuesday's patient was first detected through a CT scan on April 17, and Bhadra's team knew it was cancer within 30 minutes of this week's procedure, which took about an hour and a half.
Over the next two days, the patient will meet with radiation oncologists and surgeons to determine treatment. Although it's too soon to know for sure, Bhadra said the patient's lung cancer appears to be in the "very early stage," which gives the greatest chance for success.
"If you can identify these cancers earlier, then you can treat them earlier," Rickman said. "Once lung cancer becomes advanced, then it's very hard to have curative treatment, so most people die, even despite drug advances."
Lung cancer causes more deaths in the United States than any other form of cancer and kills more people than breast cancer, prostate cancer and colon cancer combined.
The rate of new lung cancer cases in Tennessee is 77.2 per 100,000 people, higher than the national rate of 63, according to a recent American Lung Association report. Only Kentucky, West Virginia and Arkansas had higher rates.
Although most cancer is detected incidentally, such as a CT scan for chest pain, Bhadra said advances in screening methods such as Memorial's mobile lung CT are streamlining the process, from detection, to diagnosis, to treatment.
"Instead of seeing patients late in lung cancer, we're catching them early, and these interventional techniques allow us to be able to diagnose lung lesions earlier, safely," he said, adding that better screening has shifted the majority of his patients from incurable to curable.
Between 2012 and 2016, Memorial saw an increase in the number of patients with stage 1 lung cancer — 86 to 143 — and a decrease in patients with stage 4 — 121 to 84 — according to Memorial's tumor registry data, a trend that Bhadra said illustrates the importance of early detection and the strength of Memorial's thoracic program.
"This is changing the way people in Chattanooga are surviving and living," he said. "It's a pretty powerful message that if you have a lung nodule, if you have a spot, we can catch it early — we can help you."
Contact staff writer Elizabeth Fite at firstname.lastname@example.org or 423-757-6673.