Lung scope capability is good news for lung cancer patients on Cape Cod
An ultrasound scope used to diagnose lung cancers is now being used by Cape Cod Healthcare pulmonologists at both Falmouth and Cape Cod Hospitals.
EBUS, or endobronchial ultrasound, is a 2-foot-long, flexible scope that’s inserted through a patient’s endotracheal tube. It has an ultrasound probe at the tip that broadcasts an image, allowing clinicians to see into the main part of the lung. The physician operating the scope can then activate a needle at its end to sample a bit of tissue – for example, from a lymph node – and have it tested for cancer or other conditions.
“EBUS is an incredible tool,” said Michael Ayers, MD, FCCP, an interventional pulmonologist who has been doing the procedure at Cape Cod Hospital for about four months. “It allows us to visualize the target and then actually guide a needle right into that target.” EBUS is also used at Falmouth Hospital by pulmonologist Thomas Irvine, MD.
Bronchoscopes have been in standard use since the 1980s, according to a 2015 report by researchers at the Baylor School of Medicine. But those scopes only allow physicians to peer into the center of the lungs using a tiny lighted camera. EBUS, which has been around for about 20 years, can be manipulated further into the lung, broadcasting a picture back to clinicians. It can play a “pivotal role” in determining the stage of small-cell lung cancers often seen in smokers and is a “standard of care,” the researchers said.
“The regular bronchoscope doesn’t have the ability to actually visualize, see a target – a lymph node, a mass, whatever – unless it’s inside the airway,” Dr. Ayers said. “What I’m doing with the EBUS scope is going after things outside the airway that couldn’t possibly be seen with a regular bronchoscope.”
Good News for Patients
The newer scoping systems, including some even newer robotic ones, are good news for patients, he said. “Robotic bronchoscopy allows us to get after much smaller nodules than we normally would not have been able to access. So we can diagnose cancers earlier as a result of that.”
And EBUS is used for more conditions than lung cancer.
“It’s for enlarged lymph nodes, nodules, masses, whatever. There are other things that can cause enlarged lymph nodes,” Dr. Ayers said. “So it’s very helpful in diagnosing lymphoma and other diseases like sarcoidosis, which can cause enlarged lymph nodes.
“It’s real-time imaging, real-time sampling.”
A patient might be referred for the EBUS procedure if something suspicious has shown up on an X-ray or CT scan. The procedure takes about as much time as a colonoscopy, and also is usually done on an outpatient basis.
Dr. Ayers, who’s been doing the EBUS procedure since 2007, prefers to use general anesthesia, rather than conscious sedation, because it helps to keep the patient still and prevents coughing. Once the patient is sedated, the EBUS scope, about the diameter of a pen, is worked down the endotracheal tube and into the airway. This also allows access to the lymph nodes. Once the EBUS operator finds the target, it’s possible to dispatch a small needle at the end of the probe to take a tissue sample. The procedure can take 30 to 60 minutes, depending on how many targets there are.
The tissue sample is then passed to a pathologist or cytologist in the procedure room for a preliminary evaluation. The final report on the sample takes four or five days. “The preliminary, I tell patients right away,” Dr. Ayers said. “The preliminary is generally very accurate.”
Afterwards, patients may have a sore throat from the breathing tube used during sedation and might experience coughing, including some streaks of blood or clotting, because of the irritation from the needle. And the patient may feel tired from the anesthesia – again, not too differently from after a colonoscopy.
The newest technology, Dr. Ayers said, is an even thinner robotic bronchoscope that can be guided into the outer regions of the lung. He expects that the equipment will soon be available at Cape Cod Healthcare.
“This is for more peripheral-based lesions in the outer limits of the lungs, almost to the pleura, or lining,” he said. “It's a special technology that uses very thin bronchoscopes to allow us to travel out through airways to get to these very peripheral lesions. The advancements and diagnostic procedures are really incredible.”
