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GPS for Your Lungs

New Technology Allows Doctors to Reach Deep into the Lungs to Diagnose Lesions without a Scalpel

Robert Krull and D. Kyle Hogarth, MD
When a CT scan revealed a mass on Robert Krull’s lung, the lung cancer survivor turned to his pulmonologist D. Kyle Hogarth, MD (right), who used new, minimally invasive technology to biopsy the growth.

For survivors of lung cancer, even a lingering cough from a cold can be a worrisome sign. Robert Krull, 67, knows that fear all too well.

After surgeons at the University of Chicago Medicine removed cancer from Krull's left lung in 2005, he gave up his two-pack-a-day cigarette habit. But his emphysema, family history of lung cancer and the damage caused by 40 years of smoking left the Long Beach, Ind., lawyer at risk for recurrence. Two years after the surgery, a CT scan revealed an ominous mass on Krull's right lung. "I was terrified at first and then angry that the cancer had come back when I thought I'd done everything right with my treatment," Krull said.

Krull's pulmonologist, D. Kyle Hogarth, MD, also suspected cancer. But rather than have Krull undergo another extensive surgery to biopsy the mass, Hogarth, director of bronchoscopy and minimally invasive diagnostics at the University of Chicago Medicine, used a technology called electromagnetic navigation bronchoscopy to sample the abnormal tissue. Also known by its trade name, superDimension iLogic System, the high-tech device allows Hogarth to insert a scope through a patient's mouth and maneuver it far into the lung to biopsy growths that previously required invasive measures to reach.

The University of Chicago Medicine is a leader in electromagnetic navigation bronchoscopy in the Midwest, Hogarth said. In 2004, he was among the first pulmonologists in Illinois to adopt superDimension.

A pioneer of several noninvasive technologies to prevent, detect and treat lung cancer, Hogarth wants to give individuals at risk for the disease a fighting chance. "More people die from lung cancer every year than from breast, colon and prostate cancers combined because lung cancer is typically diagnosed too late," said Hogarth, who codirects a University of Chicago Medicine clinic for people at risk of lung cancer and other malignancies.

Hogarth leads a multidisciplinary team of specialists devoted to finding and treating lung cancer at its earliest stages, as well as reducing individuals' risks of getting cancer. "We want the same early detection and vastly improved outcomes for patients with lung cancer that survivors of breast and colon cancers get from mammography and colonoscopy," Hogarth said.

Reaching Lesions Deep in the Lung

Until recently, the lungs' complex and narrow branching system has made minimally invasive diagnosis and treatment of early-stage lung cancer challenging. More than 70 percent of cancerous lesions start in areas that are outside the direct view of a bronchoscope, a tube with a light and a camera that can inspect the airways for abnormalities and biopsy them. "I can go into the first and second branches of the upper lobe of the lung with conventional bronchoscopy, but then the airways narrow as they continue branching," Hogarth said. Sometimes a biopsy is obtained by sticking a needle through the chest wall into the lung. In other cases, surgery is required to obtain a tissue sample.

But superDimension's navigation catheters allow Hogarth to safely maneuver a bronchoscope virtually anywhere in the lung. After receiving anesthesia for the outpatient procedure, Krull was positioned on an electromagnetic panel that functions as a sort of GPS, guiding the sensor-equipped scope toward the lesion. Hogarth tracked the scope's exact location on a three-dimensional road map of Krull's lungs projected on a plasma screen.

"This technology more than doubles the number of premalignant lesions we can detect." Hogarth said.

Even patients with the most challenging lung problems -- advanced emphysema, those with only one lung or with severe heart disease -- can have suspicious growths biopsied with superDimension. This technology will reduce the number of undiagnosed lesions, Hogarth said.

If lung cancer is found, superDimension also can improve treatment. Hogarth uses the navigational scope, for example, to implant tiny metal tags around a tumor, allowing radiation oncologists to more precisely and safely aim the beam at only the cancerous tissue.

When Krull woke from the 30-minute superDimension procedure, he found Hogarth grinning at him. Instead of cancer, Hogarth found what appeared to be a fungal infection in Krull's lung, which was confirmed by a pathologist. "I was elated," said Krull, who played golf the next day.

Robert Krull

Finding Cancer Early

As of his last visit, Krull is cancer-free. Hogarth wants to increase the chances of keeping him that way by checking his lungs annually for tiny lung cancers and premalignant lesions. These growths distort the tissues around them and make the airway thicker, changes that are invisible on a CT scan. The University of Chicago Medicine is one of the only hospitals in the Midwest that offers autofluorescence bronchoscopy to screen for precancerous changes in cells in individuals at risk for developing lung cancer.

Autofluorescence bronchoscopy causes abnormal tissue to glow a different color than healthy tissue and "more than doubles the number of premalignant lesions we can detect," Hogarth said. "Like a polyp in the colon, we can laser it out while we're in there and potentially prevent cancer from developing."

Seven years after being treated for lung cancer, Krull says he feels and looks healthier than he has in a long time. "Friends mention that I don't have a gray pallor since I stopped smoking, and I'm not afraid to buy green bananas," Krull joked.

And for Hogarth, there is no greater gratification than knowing that the more than 700 bronchoscopies he performs each year are "quite literally, helping to nip lung cancer in the bud."

And for Hogarth, there is no greater gratification than knowing that the more than 700 bronchoscopies he performs each year are "quite literally, helping to nip lung cancer in the bud."

This story originally ran in the Spring 2012 issue of Imagine, a quarterly magazine published by the University of Chicago Medicine.
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