Definitively Diagnosing Lung Cancer

Each year, more lung cancer patients die from their disease than prostate, breast and colon cancer patients combined, making it the leading cause of deaths worldwide. More than 90 percent of patients do not survive, in part because lung cancer is often diagnosed at an advanced stage.

But what if there was a way to diagnose small, early-stage lesions deep inside the periphery of the lungs so treatment could begin earlier and have a better chance of success?

Through Auris Health’s Monarch™ Platform, robotic bronchoscopy is now possible. Fox Chase was one of the first cancer centers in the country to offer robotic bronchoscopy through this revolutionary technology. Fox Chase clinicians are also some of the most experienced to offer these procedures.

How It Works

Physicians use a hand-held controller to navigate a small, flexible telescoping endoscope into the lung to visualize and biopsy remote areas that were previously inaccessible. The robotic platform gives physicians greater dexterity, reach, vision, and control.

The system uses computer-assisted navigation based on 3D models of the patient’s own lung anatomy, which allows physicians to visualize the lung continuously throughout the entire procedure.

Used along with endobronchial ultrasound (EBUS), the combined procedure also allows evaluation of chest lymph nodes in a single setting, which helps with timely treatment planning. And, because biopsies can be done through the endoscope, there is no need for needle biopsies and the risks they pose.

The consistency and reproducibility achieved by the platform far exceed traditional bronchoscopy, allowing for rapid and accurate diagnosis. It benefits patients by navigating the airways quickly and safely to get accurate answers.

Available Now

While there are a variety of diagnostic options currently available for lung cancer, all have limitations in accuracy, safety, or invasiveness. These limitations can lead to such as pneumothorax (collapsed lung) and hemorrhage, which may increase healthcare costs and extend hospital stays.

The Monarch™ Platform overcomes those limitations. Manley says the system is nothing short of revolutionary for difficult-to-reach nodules.

“It uses electromagnetic navigation and robotic control together, giving us turn-byturn directions inside the lung. The robotic arm gives us stability and dexterity, which allows us to reach the nodules, do the biopsies, and use fiduciary dye markers to tag the lesions so surgeons can conduct a lobectomy with precision,” Manley said. “Our hope is that eventually we will be able to diagnose and treat cancer in a single session using this or a similar system.”

The Monarch™ Platform integrates the latest advancements in robotics, software, data science, and endoscope innovation while using a controller-like interface already familiar to physicians. Its primary purpose is to dramatically improve patient outcomes, enhance physician capabilities, and lower costs.

“The clear benefit is diagnosing and staging lung cancer early. Everything we know about lung cancer says that the sooner and earlier it is found, the better patients will do,” Manley said. “Lung cancer screening can identify potential lesions, but how best to get at that nodule is the first hurdle. Robotic bronchoscopy gives us a greater ability to evaluate small lung nodules that may not otherwise be reachable by conventional means.” The design of the platform’s bronchoscope has also been perfected for navigating diffuclt areas of the lung. “The robotically controlled bronchoscope is extremely stable, allowing us to maneuver it in multiple directions.” 

Manley said. “We can navigate to small lesions deep inside the periphery of the lung and do biopsies under direct visualization, which was never possible prior to this.”

Manley believes the Monarch™ Platform’s robotic bronchoscopy system is the new standard of care for finding and treating lung cancer early.

The Patient Experience

Patients undergoing robotic bronchoscopy meet with their Fox Chase team on the day of the procedure. The entire process typically takes about three hours. The minimally invasive bronchoscopy itself usually lasts less than an hour.

Once the patient is fully anesthetized, a small, flexible endoscope fitted with a lens and tools enters the body so that physicians can look inside the lungs. The robotic navigational guide gives physicians turn-by-turn directions, leading them to the nodules. Physicians can fully visualize the lungs, biopsying tiny pieces of the nodule or lung tissue as needed. Lymph nodes are also inspected using endoscopic bronchial ultrasound (EBUS) so that lymph node staging can be done at the same time.

Patients often return home the same day as the procedure, and results are usually available within a few days. It can take longer if a biopsy was done because the pathologist needs time to carefully prepare and evaluate the tissue.

The Benefits

The robotic bronchoscopy system offers a variety of benefits, inclufing fewer side effects, false negatives/positives, and complications related to conventional bronchoscopy and needle biopsy. It enhances the ability to evaluate, diagnose and ultimately treat lung cancer by providing a definitive diagnosis after one short anesthetic session, which includes both lesion biopsies and lymph node assessments. The procedure is also safe in older patients.

In Summary, the Monarch™ Platform:

• Integrates the latest advancements in robotics, software, data science, and endoscopy
• Has a familiar controller-like interface that physicians use to navigate the flexible robotic endoscope into the periphery of the lung with improved reach, vision and control (something not possible through traditional bronchoscopy)
• Combines traditional endoscopic views into the lung with computer- assisted navigation based on 3D models of the patient’s own lung anatomy, providing physicians with continuous bronchoscope vision throughout the entire procedure

Robotic Bronchoscopy in Action: Two Patients, Two Diagnoses, and Two Positive Outcomes

The two lung cancer patients couldn't have been more different. 

One was a 79-year-old woman who had quit smoking 50 years before. The other was an 84-year-old man who never smoked a day in his life. Yet, despite their differences, screenings showed that both had suspicious spots deep inside their lungs. 

For such patients, conventional bronchoscopies only allow physicians to get so far into the lung and needle biopsies present risks of side effects. 

But, thanks to Auris Health’s new robotic bronchoscopy system, the Monarch™ Platform, Fox Chase’s Director of Interventional Pulmonology, Christopher Manley, MD, and his team were able to navigate a camera deep into the two patients’ lungs and remove tissue samples, stage their lesions, and assess their lymph nodes for cancer.

The result: the ability to quickly plan effetive treatment while the lesions were still small - and before it was too late. 

Prior to the bronchoscopy, the woman was suffering shortness of breath and a chest CT scan showed that she had a spot in her left upper lobe. While it wasn’t the cause of her breathing issue, it was Stage I lung cancer.

“Using the navigational bronchoscopy, I marked the nodule with a gold fiducial and dye,” Manley said. “That made it more precise for her surgeon to resect the small nodule. Afterwards, she had no evidence of cancer and did not need any additional treatment.”

The male patient previously had prostate cancer. When he had a CT scan done to evaluate breathing issues and a spot was discovered, his doctors thought it was most likely slow growing, metastasized prostate cancer. He sought a second opinion at Fox Chase.

What was discovered through robotic bronchoscopy was a very different diagnosis. He had early Stage III primary lung cancer, which was completely unrelated to his other cancer. That discovery made his treatment recommendations very clear— a right upper lobectomy and adjuvant chemotherapy.

“The Monarch™ Platform allows us to look at lung nodules safely and effectively." Manley said. "We combine that with lymph node staging by ultrasound. That means in one anesthetic period, we can biopsy the lung nodule and, if needed, look at the lymph nodes and biopsy any that look abnormal. This provides a lot of information that will help the patient’s oncologist, surgeon or radiation oncologist plan effecive treatment. 

Another benefit of the procedure is the ability to decrease the amount of time between when the patient presents with a lung nodule and when they start treatment.

“In the man’s case, we used navigation bronchoscopy to reach a very small lesion in the right lung,” Manley said. “We did biopsies under direct visualization and were able to isolate tumor cells and confirm that it was actually a primary lung cancer. At the same time, we looked at his lymph nodes to complete the full staging, which showed Stage III disease. He was able to have a surgical resection very early on.”

Because of the definitive diagnoses made possible by the robotic procedures, physicians were able to plan the right care for both patients.

“Both are doing well after treatment and neither show evidence of lung cancer,” Manley said. “Their cases also demonstrate how safe the procedure is for patients in their 70s or 80s, who are going home the same day with no complications.”

For patients and their doctors, robotic bronchoscopy holds promise for prompt, early treatment and quality-of-life benefits from the shorter diagnostic timeframe.

“When patients find out they have lung nodules, it’s a very scary prospect because their doctors don’t know much about them yet. The unknown is always a scary thing,” Manley said. “With the ability to reach these nodules and biopsy them, we can provide a lot of information so decisions and treatment plans can be made based on the patient’s individual case.