Columbus Regional Health is the first hospital in Indiana to offer a new minimally invasive way to biopsy a nodule on the lungs.

Early-stage lung cancer typically has few symptoms; it is usually discovered as an incidental finding on a chest X-ray or through a low-dose CT screening scan. When an abnormality such as a nodule is detected, the next step is a biopsy that takes a sample of cells from the nodule to determine whether cancer is present.

Until recently, the least invasive, most precise way to access a nodule was through electromagnetic navigational bronchoscopy, in which an interventional pulmonologist advances a bronchoscope through the throat and into the lungs with the assistance of a virtual (as opposed to real-time) navigation system.

In December 2018, Columbus Regional became the first hospital in Indiana, and one of only 10 in the nation, to offer cone beam computed tomography (CBCT) bronchoscopy, which improves on electromagnetic navigational bronchoscopy by offering real-time, 3-D, high-resolution image guidance during the procedure.

“CBCT bronchoscopy allows us to target abnormalities in difficult-to-reach regions of the lung with great precision and in a minimally invasive fashion,” said interventional pulmonologist Deepankar Sharma, M.D. “Precise placement of the biopsy needle in the center of the nodule ensures a more accurate result.” And like most bronchoscopy procedures, CBCT bronchoscopy is done on an outpatient basis.

A Team of Experts
If cancer is confirmed, treatment starts immediately. The Lung Nodule Review Board, which consists of pulmonologists, radiologists, surgeons and cancer specialists, meets every week to discuss cases. A lung cancer patient navigator helps coordinate care and guides patients through the treatment process.
“Research suggests that some types of lung cancer can progress quickly from the earliest stages, so speed is paramount,” Dr. Sharma said. “We try to take the patient from diagnosis to treatment in just a few days.

“We are one of the few hospitals in the region that can provide this level of comprehensive, coordinated care for lung cancer,” Dr. Sharma added. As director of the Lung Institute, he has helped to recruit other specialists, including Herman Dyal, M.D., who is board-certified in internal medicine and pulmonary medicine and specializes in critical care medicine. Dr. Dyal treats a wide range of lung issues, including chronic obstructive pulmonary disease (COPD), asthma, interstitial lung disease, sarcoidosis and pulmonary hypertension.

“I’m happy to be part of this growing, dynamic program,” Dr. Dyal said. “Patients can be assured that they have access to a multidisciplinary team of specialists who can successfully treat even the most complex issues close to home.”

Cancer Screening Successes
Since starting in February 2017, CRH’s low-dose CT scanning program has served 1,200 patients and detected 25 instances of lung cancer, most of which were in early, treatable stages. The American Cancer Society recommends these painless, noninvasive CT scans for people ages 55 through 80 who smoke, have a heavy smoking history (have smoked at least a pack a day for 30 years or two packs a day for 15 years), or have quit smoking in the past 15 years.

“The largest study of low-dose CT scans detected cancer in 1.1 percent of patients,” Dr. Sharma said. “Our diagnosis rate is 2 percent, which indicates the need for and effectiveness of this type of screening in our community.”