With their newest acquisition, Brookwood Medical Center becomes one of only about seven hospitals in the state to offer a procedure for diagnosing lung cancer in its earliest stages.
“Essentially the Electromagnetic Navigation Bronchoscopy (ENB) is a navigational system, like the GPS in a car. It tells us where we are in the patient’s lungs,” says Christopher Roney, MD, a pulmonologist at Brookwood.
Prior to the ENB, physicians had no detailed guide into the smaller airways of the lungs. “We’d use x-rays and other tools to biopsy lesions in those areas, but it was very inaccurate, especially for small lesions,” Roney says.
Roney has already used the ENB ten times within its first two months at Brookwood. “It’s great. It lets us do things we could not do before. The big thing is that we know right then if we have a successful procedure,” he says. In the past, without the visual accuracy of the ENB, they had to wait days for pathology to come back with results on the biopsy to let them know if they needed to extract more tissue.
In one of the first cases where Roney used the ENB, he located and biopsied a peripheral lesion only one-centimeter wide. “It was an interesting case,” he says. “The patient had a history of colon cancer that had spread to the chest.” Previous lesions had improved with treatment. And the patient had also been treated for inflammation. “But these were small, hazy nodules,” Roney says.
The ENB allowed them to non-invasively and accurately locate and biopsy the unusual lesion. “So we were able to do a biopsy on it and, during the procedure, it came back positive for colon cancer,” Roney says. Knowing immediately that the lesions stemmed from the primary cancer meant that the physicians were able to move forward with the proper treatment immediately.
Before the ENB, many patients had to endure wait-and-see periods or go through more invasive and dangerous biopsies. For example, in a needle biopsy, the risk of pneumothorax runs around 30 percent, depending on the access point. But with the ENB, that risk drops to three percent.
The accuracy of the ENB relies on both an actual camera and digital images generated using an electromagnetic field. A camera lens lies at the tip of the bronchoscope and gives physicians a limited, but direct, view of what’s in front of the lens.
The tip also generates a signal detected by the electromagnetic field surrounding the patient’s chest. “That tip tells me exactly where I am inside the patient,” Roney says. “It’s just like a GPS.” It even beeps to tell the physician when to turn.
The ENB shows the signal from the tip of the bronchoscopy within a 3-D rendering of the patient’s lungs created through a high-resolution CAT scan.
That image fills one of the six frames showing on the physician’s screen. The other frames show various views of the lungs based on the 3-D image. Because it’s a touch screen, the physician can zoom in and out and twist and turn the images as needed.
“It’s like a video game,” Roney says. A purple line on the images maps the route planned by the physician through the patient’s lung. “And we follow the line. It even makes the line dark or light to let us know if we’re moving in the proper direction.”
Roney says the ENB pairs well with Brookwood’s CyberKnife Robotic Radiosurgery System for treating lung cancer. “In a healthy patient with a small spot, we’d do surgery and take it out. But if they already had lung surgery and aren’t candidates for surgery again, we can use the CyberKnife,” he says.
CyberKnife affects a localized treatment in even very small areas. “So those patients can get targeted radiation treatment, because CyberKnife tracks respirations and moves the beam to follow the lesions,” Roney says. Physicians also use the ENB to place the markers in the lung that guide the CyberKnife.
Roney looks forward to utilizing the ENB technology regularly. “I never dreamed we could biopsy lesions as small as one cm in size, other than in the central airway,” he says. “This device allows us to treat early malignancy that we used to have to watch over for six to 24 months. Now if we see risk factors, we can target the lesions early, diagnose it sooner, and more accurately biopsy it. We couldn’t do that before.”
