June 13, 2008
A powerful new test lets physicians "see" through lung tissue, to check for lung cancer and other conditions.
It was "good news" all the way around for Kim Yeager, who became the Valley's first ultrasonic bronchoscopy patient in early May.
Kim had her procedure done at John C. Lincoln North Mountain Hospital — the first place in the Valley to offer the new outpatient test that replaces the need for major diagnostic surgery.
Ultrasonic bronchoscopy represents a less risky, yet much more effective, way for physicians to "see" through lung tissue to test for lung cancer, lymphoma, Valley Fever and sarcoidosis.
A Welcome Alternative
Formerly, surgeons had to make a major incision between a patient's ribs to sample suspicious lymph nodes or other lung tissue just so a biopsy could be done to test for disease.
"It was a big deal, very invasive, but it was the only way to get to tissue we couldn't reach with a bronchoscope," explained pulmonologist J. Burr Ross, MD.
A bronchoscope is a medical device that pulmonologists use to travel through the throat and the bronchial (breathing) tubes to perform medical procedures in a patient's lungs.
In some cases, suspicious tissue located close to the bronchial tubes could be biopsied through the bronchoscope, but "the problem always was that while we could see into the bronchial tubes with the bronchoscope, we could never see exactly where suspicious tissue was located on the other side of the tissue wall," Dr. Ross explained.
Seeing Through Walls of Lung Tissue
"Now, specially trained lung specialists can accurately biopsy previously invisible and difficult-to-access lymph nodes and tissue masses with the help of ultrasound images obtained through the bronchoscope," he said.
Dr. Ross, who performed the Valley's first such procedure on Kim in North Mountain's endoscopy suite, explained that the miniature ultrasound wand travels with the bronchoscope into the patient's lungs via the bronchial tubes. The images it picks up allow doctors to "see" through the walls of the lung tissue to identify suspicious lesions.
"It was cool," Dr. Ross said. "We could actually see all the major blood vessels, the pulmonary artery and the aorta, and know exactly where to biopsy the lymph nodes."
This was particularly valuable during Kim's procedure, because the lymph node Dr. Ross needed to biopsy was located behind the bronchial tube wall right between Kim's pulmonary artery and aorta.
Once suspicious tissue is targeted, a biopsy needle is used to obtain cell samples, which are immediately reviewed for definitive diagnosis by a specialist from the hospital pathology lab. In order to expedite lab testing, the pathologist or cytotechnologist is present and ready to work in the procedure room where the ultrasonic bronchoscopies are done.
Finding Disease at an Earlier, MoreTreatable Stage
"The procedure went so smoothly," said Mindy Kear, representative for Olympus, which makes the medical device used in ultrasonic bronchoscopy. "Dr. Ross just slid into perfect position and nailed the lymph node. He was amazing."
The procedure, which takes 30 to 45 minutes, usually is performed with patients under conscious sedation, thus avoiding general anesthesia. In Kim's case, however, because it was the first procedure for both Dr. Ross and the hospital, Kim was completely anesthetized.
"The really good thing about this procedure — in addition to its less invasive nature — is that it allows us to reach less accessible lymph nodes than we can sample in a traditional biopsy," Dr. Ross said. "Additionally, this procedure allows us to find evidence of disease at a very early and more treatable stage."
"I feel great," said Kim, a couple of days after the procedure was complete and biopsy results showed her tumor had not spread to her lymph nodes. "It didn't hurt. Dr. Ross is not only a great doctor, he's just so nice. It really makes a difference."
Both Dr. Ross, a partner in Pulmonary Associates, and Khaled Saleh, MD, from Affiliated Chest Physicians, traveled to Baltimore for special training in ultrasonic bronchoscopy and offer this procedure at North Mountain.
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