New diagnostic device allows early detection of lung cancer, better survival odds
Essentia Health in Fargo is among the first to use a robotic endoscopy apparatus that allows low-risk access to hard-to-reach lung nodules in early development.
FARGO — Helen Barr’s back was bothering her. To diagnose the cause, her doctor ordered a scan that happened to also capture a surprising find: a small spot in her right lung.
Since that incidental discovery in 2018, her doctors have kept an eye on the slow-growing mass, which isn’t causing any symptoms.
Barr, an 82-year-old grandmother from Park Rapids, Minnesota, went in recently for a procedure at Essentia Health to get a biopsy sample so her doctors can devise a treatment plan. Imaging studies have shown the nodule is gradually getting larger.
“That is a slow-, slow-moving one,” Barr’s son, Kelly, said. More worrisome, “It had fingers on it.”
To find out if the growth is malignant and, if so, to determine a treatment plan, her doctors needed a biopsy.
Instead of having a long needle inserted between her ribs, penetrating inside her lung, Barr was placed under anesthesia and her physician used a novel endoscope, guided by a handheld control device much like those used by video gamers.
“Historically, this was the only way to reach these nodules” located deep inside the lung, out-of-reach to ordinary endoscopy, or the use of tiny cameras inserted into natural body openings, said Dr. Karol Kremens, Essentia’s director of critical care, and the physician who performed the procedure on Barr.
Needle lung biopsies are painful. “You can only numb the skin so much,” he said. “You’re going to have pain.”
Barr was spared that, and was able to sleep through the procedure thanks to anesthesia.
“You go to bed, you wake up, you’re done,” Kremens said.
Not only is the new diagnostic method not painful, it’s also vastly less risky — needle biopsies carry a 30% risk of complications, including a collapsed lung. And crucially, it enables much earlier intervention, said Kremens, who has been trained to use Auris Health’s Monarch Platform.
The new medical technology, which Essentia is among the first to adopt, combines robotics, software, data science and endoscopy to reach small, hard-to-reach nodules in the periphery of the lung.
With practice, the handheld controller is easy to operate, as the physician snakes the tiny camera — smaller than a standard endoscope — into progressively smaller airways inside the lung.
The robot can be immobilized to eliminate any unintended movement; standard endoscopes allow “micromovements” by the physician’s hands, Kremens said. “The beauty of this thing is its stability,” he said.
The robot responds to signals from the Xbox-like controller, “So we no longer really use our hands,” Kremens said.
The innovative device makes it possible to get a biopsy earlier in the development of a tumor — enabling treatment to start before cancer can progress to an advanced stage, when survival rates are much lower, Kremens said.
As a result of an all-too-frequent late diagnosis, more than 90% of those diagnosed with lung cancer don’t survive the disease. Lung cancer claims more lives every year than prostate, breast and colon cancers combined.
“The whole point is catching cancer early,” Kremens said. “This is truly where the survival benefit for patients is.”
Because smokers are at greater risk for lung cancer, they are given annual screening scans starting at age 55 to catch cancer signs early.
Barr, whose entire working career was as a nurse’s aide, acknowledges that she was a smoker. “That was the thing to do back then,” she said.
Living with the uncertainty caused by the nodule in her lung has weighed on Barr since it was discovered almost four years ago. “Mentally, probably a little,” she said. “You worry about it.”
Uncertainty has been something she’s lived with for many years. She was diagnosed years ago with a very slow-progressing case of leukemia.
The Barrs will weigh the results of the biopsy, and consult with her doctors about treatment options.
“It all depends on what the doctors say,” Kenny Barr said. “It’s ifs and buts.”
If the tumor is found to be malignant but slow-growing, “I doubt cutting would be part of it,” he said. Radiation and chemotherapy treatments could be an option, however, he added.