'Lung GPS' may offer roadmap to cancer

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http://www.rctimes.com/apps/pbcs.dll/ar ... 4/MTCN0303

'Lung GPS' may offer roadmap to cancer

By JOY BUCHANAN

Staff Writer

Paula Harris thought she was in trouble.

A rare, but potentially dangerous, side effect of the powerful drugs she takes for rheumatoid arthritis is lymphoma, a cancer that often appears in the lungs. She had good reason to be concerned about the persistent cough she developed earlier this year.

"You feel like you can't get a deep breath," she said. "Your chest feels tight and you cough."

Until very recently, doctors would not have been able to take samples of the suspicious masses they discovered in Harris' lungs without cutting through her ribs or using a needle biopsy that could have caused her lung to collapse. Instead they would have watched and waited, perhaps for years, hoping the masses were not cancerous.

But Harris didn't have to wait long for her diagnosis. A new computer system and scope at St. Thomas Hospital is capable of snaking deep into the lungs and allowing doctors to do biopsies without surgery or risking a collapsed lung.

The navigational bronchoscopy, or "lung GPS," creates a 3-D roadmap of the lungs. Then doctors use a modified scope to travel into the lungs far beyond the first bronchial branches. Doctors hope this will help them spot lung cancer in earlier stages, when it is most treatable.

"This is very exciting to us," said Dr. Jeff Wright, a pulmonologist with St. Thomas Medical Group. "This is the biggest step forward in diagnostic pulmonary technology in the last 25 or 30 years."

It's not a lung cancer screening test, nor is it an appropriate procedure for everyone. It will likely be used on patients with lesions or spots in the lungs that would be difficult, if not impossible, to reach otherwise or who are at highest risk of complications from needle biopsies or surgery.

The new technology helps doctors quickly diagnose patients like Harris, who had three enlarged lymph nodes in the center of her chest; two of which would have been unreachable using older techniques.

Doctors took a CT scan of Harris' chest. The new computer program created a virtual map of her lungs from the scan.

"It's almost like playing a video game where you're driving through the patient's lungs," Wright said.

The doctor marks the spots in the lung to biopsy and programs them into the computer. Then, the patient is deeply sedated. The bronchoscope, which is narrower than a pencil, is put down the throat and into the lungs. The extension on the scope is even narrower, and it is the reason doctors can get much deeper into the lungs with greater precision. On a screen, the doctor can see the image of the lungs projected by a camera in the scope, beside the virtual map made by the computer. The doctor biopsies the lesion or mass with tiny instruments threaded through the scope.

Wright took samples of the three masses in Harris' chest. None of them were cancerous. Instead, she was diagnosed with sarcoidosis, a condition in which inflammation produces tiny lumps of cells in various organs. The lumps can clump together and interfere with organ function.

"Our goal is to get our patients diagnosed as quickly as possible to give them peace of mind," Wright said.

Harris was relieved to know what exactly was wrong with her lungs right away. She now takes medicine to reduce inflammation.

"It makes all the difference in the world," she said. "I was really wanting to breathe." •