If we could turn back time; if, before the ragged cough developed, before symptoms were recognized too late, if we could detect this lethal killer in its early, much more curable stage, many of the people who will die this year from lung cancer probably would have lived.
Electromagnetic Navigation Bronchoscopy (ENB) has been available for four years. It is accessible at multiple locations in Birmingham and across Alabama. However, its life-saving potential to diagnose lung cancer early was a missed opportunity for too many people. There has only been a slight decrease in the number of lung cancer cases diagnosed at stage three since this option has been available.
The question is—why? Perhaps the effectiveness of ENB in diagnosing even tiny nodules in hard-to-access peripheral areas of the lungs should be more widely known within the medical community. Perhaps patients at high risk would be more inclined to seek screening if they knew a less invasive option was available that could give them either the peace of mind of a benign diagnosis, or an opportunity to head off an emerging problem while there is still time to make a difference.
“What I’d like to see here in Birmingham are programs similar to those in other areas--screening of patients known to be at risk, combined with an ENB follow-up when indicated,” Trinity Medical Center pulmonologist Karl T. Shroeder, MD, said. “Most cases of lung cancer are asymptomatic until the disease has progressed. Early detection is the key to helping more patients survive.”
One in 500 chest x-rays show peripheral lesions, but 65 percent of those are in locations traditional bronchoscopes can’t reach. ENB gives pulmonologists the ability to investigate targets in areas that were previously inaccessible without a more invasive procedure.
“Because of the risk of complications, particularly in patients with poor lung function, the usual approach has been watchful waiting,” Shroeder said. “However, in lung cancer, time is life.”
Lung cancer is the most frequent cause of cancer deaths in the United States. With early diagnosis, 88 percent of patients can look forward to being alive ten years after treatment. However, with a late diagnosis, only 16 percent survive.
Shroeder begins the procedure using a CT image and software to create a 3-D map of the target’s exact location. He then plans the optimum pathway to reach the location within the lungs.
“With a fluoroscope, there’s no way to see depth, but with ENB, you know exactly where you are. It’s a safer method for sampling peripheral lesions with a high diagnostic yield independent of lesion size and location,” Schroeder said. “If the nodule is malignant, when surgeons go in, they know exactly where to go and what they need to do.”
Using ENB, Shroeder guides a catheter capable of 360-degree steering deep within the lungs to biopsy suspect tissue. He was able to diagnose a 6mm nodule, one of the smallest diagnosed to date in the United States.
“When we detect lung cancers in small nodules, they are usually stage one or stage two. Fortunately, most of the nodules I’ve diagnosed turned out not to be cancer. Some were related to infections. Granulomas are more common. ENB is helpful in diagnosing sarcoid nodules and other lung conditions.”
ENB can also be a better option for some patients who may be too fragile for other procedures. It typically requires about an hour to an hour and a half in the OR, so patients would need to be well enough to tolerate general anesthesia. As of now, ENB equipment isn’t used in patients who have pacemakers.
When should patients be referred? If suspected lesions are seen in routine x-rays or diagnostic imaging, prompt follow-up could be lifesaving. For patients who have known risk factors—a history of smoking, environmental exposure to cancer-causing agents, a family history, or other risk factors, particularly as they approach an age when lung cancer typically emerges, screening should be considered, with ENB follow-up if there are targets that need further study.
For patients who get the good news of a benign diagnosis, ENB prevents the risks, pain and expense of unnecessary procedures. By giving clearer answers early, it gives those diagnosed with lung cancer a head start on successful treatment.
To both, it brings relief from the prolonged stress of waiting and wondering.