New robotic technology at PeaceHealth St. Joseph in Bellingham will help diagnose lung cancer earlier in patients.
“[Lung cancer] is less common than breast and colon and prostate and skin cancer, but it kills more people,” said Dr. Omar Jaffer, a pulmonary specialist at PeaceHealth St. Joseph in Bellingham.
More people die from the disease than those four types of cancer combined in part due to patients showing no symptoms until advanced stages and the difficulty of biopsy — gathering a sample of tissue to be examined by a pathologist. The disease killed 132,000 people nationally in 2022.
However, early diagnosis can dramatically improve a patient’s chance of survival, as mortality rate increases by about 12% a month for every month they’re not diagnosed, explained Dr. Donald Berry, a pulmonologist and the chief of medical specialty care for PeaceHealth Medical Group.
Enter the Intuitive Ion Robotic Bronchoscopy.
This robotic-assisted platform allows doctors to identify and navigate a path to an abnormal growth — known as a nodule — and biopsy it. The physicians can even use it to mark a specific area in the lung that is problematic, allowing surgeons to better target the cancer cells and limit how much lung is removed in a procedure.
“Our hope is that we diagnose these earlier, when they’re still highly curable, as opposed to waiting around for it to spread,” said Dr. Berry, who spent the last two years working to bring the cutting-edge technology to Bellingham. The hospital is one of 11 in the state using the system.
In 2011, a breakthrough screening trial for lung cancer revealed that it was possible to decrease mortality rates by identifying potential cancer nodules with CT scans in high-risk populations.
“The good thing about that is now we found all these nodules,” Dr. Jaffer explained.
The bad news was that the conventional approach required an invasive biopsy starting from outside the lungs or the removal of the area before knowing if it was cancerous, he said.
Based on data from the trial, 20% of nodules removed weren’t cancerous, resulting in unnecessary procedures on a vital organ.
The Ion system provides a less-invasive alternative that can result in fewer visits to the hospital.
With the kind of excitement that’s usually reserved for a kid at Christmas, Dr. Jaffer explained how the device works, demonstrating on a pair of synthetic lungs.
Using a console equipped with a scrolling wheel and a roll ball, Dr. Jaffer moved a scope with a tiny camera on the tip down the throat and into the lungs.
Despite the narrow, diverging passageways, he gently navigated toward a nodule, watching a large display that showed both the direct camera feed and a 3D, computer-generated version of the lungs built from the CT scan.
The ultra-thin, flexible scope of the system allows Dr. Jaffer and his colleague Dr. Amir Gharaei to access parts of the lung from the inside that they’ve never been able to before.
Traditionally, internal access has been limited to the middle of the lungs, while access to the peripheral areas required much more invasive procedures.
“More than 70 percent of all lung cancer nodules are located in the outer one-third of the lung, an area full of tight spaces and narrow airways that may be hard to reach,” Dr. Jaffer said.
However, that is exactly what the Ion system is capable of doing.
Once the path to the nodule is laid, the camera is removed and a new attachment is added that allows the doctors to take a sample of the tissue. It is even possible to do a cryobiopsy, which is a procedure that rapidly freezes an area of the lung before extracting it, providing significantly better samples for pathologists, Dr. Gharaei said.
The Ion system can also be used to help diagnose types of interstitial lung disease, which is a group of disorders that cause inflammation or scarring in the lungs, as well as Valley Fever, explained Dr. Gharaei.
“We’ve got a bunch of patients that are snowbirds,” Dr. Berry said. “They go to Arizona, they come back with Valley Fever.”
The illness, caused by fungus, can be treated with antifungal medications once it’s been identified. And, it can be identified with the Ion system.
“We don’t want anything growing in our lungs,” Dr. Berry said. “We don’t care if it’s cancer or not.”
The doctors urged patients who are considered at risk for lung cancer to talk to their primary care providers about a screening.
“Whether we like it or not, insurance companies drive a lot of this,” Dr. Berry said, noting that there are limitations on who insurance companies consider high-risk.
These are currently people between 50 and 80 years old who have at least “20-pack” years of smoking, which is considered a pack a day for 20 years or half a pack a day for 40 years. Additionally, they must have stopped smoking in the last 15 years.
“This is a moving target,” Dr. Berry said. “These screening things will change over time and they may not be adequate for women.”
He noted an increased risk of lung cancer in women who are non-smokers, specifically of Asian descent.
Dr. Jaffer said in Whatcom County, exposure to asbestos is also a primary source of increased risk.
“We have a lot of patients that were in the Navy or patients that come to us from Oak Harbor, and they have quite a bit of asbestos exposure,” he said. “Those patients, you could argue, should also be screened.”
Isaac Stone Simonelli is CDN’s enterprise/investigations reporter; reach him at isaacsimonelli@cascadiadaily.com; 360-922-3090 ext. 127.
