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GPS FOR THE LUNGS
By Rich Klindworth
ECU News Services
When it comes to treating lung cancer, the multidisciplinary team of physicians and support staff at East Carolina University’s Brody School of Medicine and Vidant Medical Center believe that time matters, as does effective, accurate and advanced therapy tailored to the individual patient.
“When you have a lung abnormality and someone tells you that this could be potential cancer, that’s an emergency to that patient,” said Dr. Mark Bowling, the Walker Distinguished Professor of Clinical Oncology at ECU and director of interventional pulmonology at Vidant. “That patient deserves to be seen quickly, have this abnormality assessed and treated quickly.”
One way Bowling does that is with an electromagnetic navigational bronchoscopy. He has become an international leader in using ENB, and the ECU/Vidant team performs more navigational bronchoscopies than anyone else in the country. Navigational bronchoscopy is like a regular bronchoscopy, where a camera is inserted down the patient’s throat to inspect the lungs; however, with ENB, that scope is connected to a computer. The computer uses a 3-D reconstructed CT scan of the chest and guides the doctor through the lungs to the precise spot of the abnormality to inspect it.
“When you look at the actual monitor, you see something that looks just like a GPS in a car,” Bowling said. “You’re able to sample things that traditionally we would not be able to get to accurately with a regular bronchoscope.”
Thanks to ENB, he said, they have an 80- to 90-percent chance of reaching a remote lesion in the lungs that traditionally they would have had a 20-percent chance of reaching.
Another benefit of ENB, Bowling said, is it enables the team to consolidate several procedures into one, saving valuable time. Typically, they will biopsy the area. After that they will place three to four gold markers, or fiducials, where the abnormality is to show a radiation oncologist precisely where radiation therapy will be needed or to help a surgeon pinpoint which tissue should be removed.
During the same procedure, Bowling can use tools such as an endobronchial ultrasound bronchoscope to biopsy the lymph nodes, as well.
Time is of the essence for patients like Pam Black, who was told she had six to eight weeks to live when she was diagnosed with stage 4 lung cancer. “This type of cutting-edge technology allowed me to have a quick diagnosis and plan of attack for eradication of this terrible disease,” Black said. She has now passed the three-year mark from her original diagnosis.
Bowling said an alternative way to get lung biopsies and place fiducials requires inserting a needle into the body. He says while this method is accurate, there is a risk for the lung to collapse. And putting three to four fiducials in an area requires three or four needle insertions, further increasing the risk of a collapsed lung.
ECU thoracic surgeon Dr. Carlos Anciano uses ENB to “tattoo” – or mark with dye – the outside of the lung so he can identify the exact spot to focus on during surgery.
In October, Bowling presented research on ENB procedures at the 18th World Conference on Lung Cancer in Japan, hosted by the International Association for the Study of Lung Cancer. Among the dozens of U.S. and European cancer programs represented there, ECU and Vidant are leading the way in ENB, he said.
“Our program is designed to be very effective and efficient. It gets us what we need up front and early so the patients can go on and get their treatment,” Bowling said.