Atrium Health Offers Latest Advancements in Diagnostic Bronchoscopy
In recent years, innovations in bronchoscopy – the use of a fiberoptic camera designed to internally examine the airways of the lung – are rapidly advancing the field of pulmonary medicine. The pulmonary care team at Atrium Health offers the latest advancements in diagnostic bronchoscopy, including the latest ultrasound and robotics technologies, to offer precise and minimally invasive testing to patients. This means improved diagnostics that drive personalized treatment plans, as well as an improved patient experience.
“We do a tremendous job at Atrium Health offering the most advanced diagnostic procedures,” says Dr. Jaspal Singh, medical director of Innovation and Quality Improvement for Pulmonary Oncology at Atrium Health and Levine Cancer Institute. “Atrium Health and Levine Cancer Institute have invested in state-of-the-art cancer diagnostic and treatment options for all patients, not just near our flagship location, but at sites throughout the area. We do this for everyone, including for our underserved communities.”
The pulmonary team consulted with team members at the Sanger Heart & Vascular Institute, Levine Cancer Institute, radiology, emergency medicine, primary care, and endoscopy, to elevate this work and were supportive in bringing this program to fruition.
Meeting a Growing Demand for Lung Diagnostics
More people than ever are seeking diagnostics of the lung, according to Singh. There are multiple reasons driving this demand, including an aging and increasingly medically complex patient population. Such patients may be at risk for lung cancer, difficult-to-diagnose infections, or other concerning diseases. When patients get chest scans for respiratory and cardiac conditions, including COVID-19, those scans may reveal incidental lung nodules or other findings that require closer examination or even invasive testing, such as bronchoscopy.
“We’re seeing a substantial increase in demand for lung diagnostics,” Singh says. “Sometimes the incidental findings may need prompt evaluation. And, of course, as the lungs are the number one target for COVID-19, more people are getting chest imaging in the first place.”
In addition, the U.S. Preventive Services Task Force (USPSTF) expanded its recommendations this year for lung cancer screenings. Because lung cancer symptoms don’t usually present until later stages, lung cancer can be detected much earlier and at a potentially curable stage through use of low-dose CT screening (LDCT) of the chest. When LDCT detects an abnormality, tools such as bronchoscopy are often needed to precisely define the abnormalities.
“After an abnormality is discovered on a low dose screening CT of the chest, patients want an accurate, quick and low-risk assessment of their risk of having lung cancer, and our team can help provide that,” Singh says.
Such early detection and advanced diagnostics can lead to effective, personalized treatment plans aimed to improve the chance of cure.
In more advanced or related cancers, advancements in bronchoscopy can help provide larger biopsy samples at minimal risk to the patient. Such biopsies can also provide insight into newer treatment options for patients.
“Understanding the biology of a patient, including molecular testing of a cancer, is key to understanding some of the treatment options today,” Singh says. “With advanced biopsy techniques, we can better understand the behavior of that cancer, provide the patient additional options and do so with minimal risk to the patient to obtain that information.”
Because of incidental findings, more lung cancer screenings and demand for more advanced lung biopsies, there has been tremendous opportunity to expand pulmonary diagnostics.
An Easier Patient Experience with Improved Diagnostic Results
Due to innovations in advanced bronchoscopy, patients can have a minimally invasive procedure that provides accurate diagnostics with very low risk.
“Today we often biopsy multiple sites of the lungs in a single sitting and return results rather quickly,” Singh says. “So, a patient can often undergo a complex biopsy procedure during the morning and still be home in time for lunch or dinner with their loved ones. In a couple days, we can give them far more information than they would have had from alternative approaches years ago.”
One exciting innovation in pulmonary diagnostics is robotic bronchoscopy, in which a tiny camera is robotically driven by the pulmonologist or surgeon through the airways for increased precision and control. Another is the use of real-time linear and radial endobronchial ultrasound (EBUS), which improves the visibility of lung tissues as well as areas adjacent to the lung, such as the lymph nodes. The Atrium Health team uses virtual and electromagnetic navigation (VMN and EMN, respectively), which Singh compares to a GPS system. These work alongside the patient’s CT image for more precise navigation deep inside the lung. These procedures are coordinated through Atrium Health’s Jan & Ed Brown Center for Pulmonary Medicine as well as other pulmonary offices throughout Atrium Health.
“The biopsies done now with these minimally invasive and precision-guided techniques are extremely powerful, and oftentimes, they can give us the answers that we need based on very tiny tissue samples from several sites during the same procedure,” Singh says. “Our laboratory colleagues then take the specimens and do a thorough job analyzing these specimens, allowing us to make very complex clinical decisions based on small samples of tissue.”
Team Approach
These diagnostic results are then shared with a multidisciplinary team of radiologists, surgeons, medical oncologists, and radiation oncologists. Together, they view the diagnostic information to create a treatment plan to present to the patient.
Singh shares that while a patient may be seen by him during an appointment, they also have an entire team working together to share information to present the patient and their family with the team’s recommendations.
“It gives me immense pride to work at Atrium Health and Levine Cancer Institute, where we have a whole team working together so that clinical options for patients are not based on just one individual’s opinion nor a special tool or technology – it’s about everyone coming together to share in that patient’s journey,” says Singh.
For more information:
Lung Nodule Program │ Atrium Health
Lung Cancer Screening Program │ Atrium Health
Referrals:
If a patient has a PCP that can refer them that is the preferred method. The PCP can send in a referral to through the LCI New patient referral center. If the patient does not have a PCP then is a "self- referral," please reach out via Cerner to Ivory Benton RMA, the referral coordinator, which would require a diagnosis of cancer and patient contact info in the message.