Advanced Bronchoscopy

The University of Chicago Medicine is a leader in applying innovative solutions that enhance diagnostic accuracy and improve treatment of a full range of lung diseases.

Less Invasive Option Provides Unparalleled Access to Tiny Lung Structures

We are the first hospital in Illinois to use the superDimension inReach™ System to identify and, in some cases, treat cancer and other medical concerns within the maze of the lungs’ airways. This technology extends significantly beyond the capabilities of standard bronchoscopes, enabling physicians to locate pre-cancerous and cancerous lesions deep within the airways -- without any incisions or surgery.

At the University of Chicago Medicine, we have more experience than any other Illinois hospital in using this advanced inReach bronchoscopy system. The Advanced Bronchoscopy Center, a part of the University of Chicago Center for Advanced Lung Diseases, is a regional leader in using this state-of-the-art technology to reach lesions that previously were only accessible through surgical means -- or could not be reached at all. With this innovative technology, cancerous lesions buried in the bronchial airways can be reached, biopsied and even removed -- without any incisions for access. No incisions mean there is no scarring, minimal pain or discomfort, and patients can resume normal activities quickly. The procedure is performed on an outpatient basis.

University of Chicago physicians also use this technology to fine-tune diagnosis and treatment of non-cancerous lung diseases, including sarcoidosis, interstitial lung diseases, infections within the lungs, and emphysema.

How inReach Bronchoscopy Works

The inReach advanced bronchoscopy technique combines sophisticated technologies, including: electromagnetic global positioning system navigation (similar to GPS technology available for cars), three-dimensional CT scanning (which shows the patient’s lung in fine anatomical detail), a sensor-equipped steerable catheter that permits 360-degree travel through the lung’s complex bronchial tree, computer software, and other specialized equipment. These elements combine to create powerful capabilities for diagnosing lung cancer and other diseases of the lung.

The system enables physicians to reach lesions within the lungs and chest that are visible on chest X-rays but are unreachable with standard bronchoscopes. This is a non-surgical alternative to more traditional options for reaching into the bronchial tree, such as a mediastinoscopy procedure (which requires an incision in the throat to insert the scope), CT-guided biopsy, or open chest surgery. In contrast, the advanced bronchoscopy procedure using the inReach technology is performed through a bronchoscope inserted into the mouth or nose and down the windpipe -- so there are no surgical incisions.

How Advanced Bronchoscopy Is Used

Physicians at the University of Chicago Medicine use the inReach system as well as other advanced bronchoscopy technologies for a variety of applications, including:

  • Biopsies of lesions or masses situated in hard-to-access locations within the bronchial branches. This ability to biopsy previously unreachable lesions means that tumors can be found, biopsied and treated at an earlier stage when there is the best likelihood of successful treatment.
  • Supplementary diagnostic testing for other lung diseases, including interstitial lung diseases, sarcoidosis and emphysema.
  • Alternative to invasive surgery for diagnosing many conditions within the lungs.
  • Diagnosis and staging of lung cancer through use of transbronchial needle aspiration of the lymph nodes. As an alternative to mediastinoscopy, the transbronchial approach avoids any incision to the patient’s neck or airway.
  • Identification and treatment of pre-cancers in the airways, often during a single procedure.
  • Diagnosis of enlarged lymph nodes located within the mediastinum deep within the center of the chest.

Advanced Technologies Detect Early-Stage Lung Cancer

Physicians at the University of Chicago Medicine are using other advanced bronchoscopy techniques to find and remove pre-cancerous lung lesions at their earliest and most-treatable stage. Adding autoflourescence capability to conventional bronchoscopy tools significantly enhances the physician’s ability to detect lesions as early as the stage 0 pre-cancerous phase -- when the lesion is just a few cells in thickness and barely visible to the naked eye.

Pre-cancerous tissue found in the lung is called "intraepithelial neoplasia." Without removal, intraepithelial neoplasia can progress to squamous cell carcinoma, the second most common type of lung cancer.

Intraepithelial neoplasia can be compared to polyps -- a pre-cancerous stage for colorectal cancer that can be found and removed during colonoscopy, or cervical dysplasia -- a pre-cancerous stage for cervical cancer, which can be found during a Pap test.

Conventional bronchoscopy uses "white light" to see inside the lungs, which makes it difficult for the physician to see lesions until they have grown. With fluorescence lighting, tiny lesions illuminate as red areas that are more easily detectable, allowing the physician to remove the lesions before they have any opportunity to grow or invade lung tissue.

Initial results from more than 3,000 patients at multiple medical centers found that adding autoflourescence to conventional bronchoscopy doubled the number of lesions identified, compared to standard bronchoscopy.

Minimally Invasive Biopsy Offers Benefits Over Traditional Biopsy

Physicians here also are leaders in using minimally invasive methods to biopsy lymph nodes in the lungs -- a key step in the staging of suspected lung cancer.

The newer process, called transbronchial needle aspiration, may be recommended after a CT/CAT scan reveals an abnormal lymph node, which may indicate lung cancer. Conventional lung biopsy methods usually require surgery to reach a lymph node and extract a tissue sample for biopsy testing. Patients typically stay overnight in the hospital.

In contrast, with transbronchial needle aspiration there is no need for exploratory surgery to reach the lymph node. Instead, the physician can pass a special needle through the bronchoscope to reach the suspect lymph node and extract tissue for biopsy. This advance means that patients can avoid unnecessary diagnostic surgery. Transbronchial needle aspiration is done on an outpatient basis, usually takes less than 1 hour to complete, and allows patients to return home later the same day.

Focusing on Cancer Prevention

Preventing cancer is the very best "cure." The Upper Aerodigestive Cancer Risk Clinic at the University of Chicago Medicine is a dedicated program that aims to prevent cancer or cancer recurrence in people at high risk for cancers of the "upper aerodigestive tract," including:

  • Lung cancer
  • Head and neck cancer
  • Esophageal cancer
  • Mesothelioma
  • Other rare malignancies of the airways and chest

» Learn more about the Upper Aerodigestive Cancer Risk Clinic

Research Opens New Frontiers

Physicians here regularly participate in research aimed at improving options for people with lung diseases. For example, the University of Chicago is part of several international studies of non-surgical lung volume reduction procedure for patients with advanced emphysema, to allow better functioning of remaining healthy tissue. While this usage is still being evaluated, early results are encouraging.

At the Forefront with State-of-the-Art Techniques

Board-certified University of Chicago pulmonologists are leaders in applying promising new technologies and innovative methods to address lung cancer and chronic respiratory conditions such as emphysema, sarcoidosis, and interstitial lung diseases. These innovations offer patients better ways to detect and treat complex lung diseases. At the University of Chicago Medicine, patients have access to the full spectrum of options, from conventional approaches to leading-edge innovations. Whether choosing the very newest methods or more established approaches, our team tailors their recommendations to meet each patient’s specific needs and preferences.


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D. Kyle Hogarth, MD:
Advanced Bronchoscopy


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