Professor Pallav Shah
Consultant Physician in Respiratory Medicine, Royal Brompton Hospital
Robot bronchoscopy technology can revolutionise the way that lung cancer is detected and diagnosed — and offers the potential of immediate treatment for some patients.
When diagnosing lung cancer, speed is of the essence — it’s vital to find and biopsy cancerous nodules as early as possible.
“If we can treat a tumour when it is less than 10mm in size, the cure rate is more than 92%,” explains Professor Pallav Shah, consultant physician in respiratory medicine, Royal Brompton Hospital, part of Guy’s and St Thomas’ NHS Foundation Trust. “Between 10mm and 20mm, the cure rate is around 83%. However, if the growth is more than 30mm with spread to lymph nodes, the cure rate decreases to the low 40%.”
Robotic bronchoscopy improves lung tumour diagnosis
There are issues locating small lung tumours with a traditional bronchoscopy, which involves inserting a camera into the airways via the mouth. Standard bronchoscopes lack manoeuvrability and accessibility to outer areas of the lungs.
With traditional computerised tomography (CT)-guided transthoracic lung biopsy where the needle is inserted through the chest, there is also an increased risk of puncturing the lung.
However, since April 2023, Professor Shah and his team have utilised new robotic technology, — the Ion Endoluminal System — which he hails as a ‘game-changer’ for earlier detection and treatment of small cancerous nodules.
If we can treat a tumour when it is
less than 10mm in size, the cure
rate is more than 92%.
Many benefits of robotic biopsy technology
Using a robotically controlled catheter system, the tool (which enters the airways via the mouth) is extremely flexible and can move 360 degrees. “With Ion, we can now reach the periphery of the lung and biopsy hard-to-reach nodules,” says Professor Shah.
“Navigation is also made easier because the technology creates a 3D route map, which enables us to precisely find and lock on to small nodules. Previously, when trying to biopsy a nodule of less than 20mm, our success rate was around 65%. The new technology has increased this to 97%.”
The procedure, which also decreases the risk of lung puncture, is performed under general anaesthesia, takes around 25 minutes and enables patients to go home two hours later.
Enabling immediate nodule treatment
Professor Shah and his team are trialling the possibility of using robotic technology to provide immediate treatment when suspicious nodules are found. “This technology has been designed as a diagnostic tool,” he admits. “However, with seven patients, we have used it to find and immediately ablate nodules using a new microwave catheter. technology — a type of ablation tool called the MicroBlate Flex, from UK company Creo. This a world-first, barrier-pushing development — although still in the study phase.”
He says the new technology has been revolutionary. “But, I’m pragmatic and think there is space for different methods of nodule identification and biopsy,” he notes. “We want as many tools as possible, so we can do what is best for patients.”
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