Lung cancer is the leading cause of cancer-related deaths in the United States (US) and the whole world (1,2). The American Cancer Society estimates that there will be about 234,000 new cases of lung cancer in 2018 in the US, and 2012 statistics estimated 313,000 new cases annually in the European Union (3,4).
Non-small cell (NSC) lung cancer is the most common type, accounting for 80%-85% of all new cases of lung cancer (3). About 6 people in 100 will develop lung cancer at some point during their lifetime (5).
The median length of time that a person is alive after a NSC lung cancer diagnosis is about 11 months (6). At 5 years after diagnosis, approximately 18% of those patients with lung cancer are surviving (5).
With identification of lung cancer at an earlier stage, patients may be treated sooner and have a better chance of survival. About 92% of patients diagnosed with localized stage IA1 NSC lung cancer are surviving at 5 years, About 83% of patients diagnosed with localized stage IA2 NSC lung cancer are surviving at 5 years and more than half (about 60%) with stage IIB NSC lung cancer are surviving at 5 years (7).
Proper treatment relies on a definitive diagnosis of the type of lung cancer. The results of pathology tests can influence the fate of treatment and a patient’s outcome (8). A definitive pathology diagnosis gives the patient the opportunity to receive the most effective treatment(s) of their cancer (8).
Many techniques are available to obtain lung lesion samples for analysis. Available techniques for lung tissue sampling include bronchoscopy with or without transbronchial needle aspiration, endobronchial ultrasound with needle aspiration, thoracoscopy, CT-guided transthoracic needle aspiration, and mediastinoscopy (11). Some of these techniques are more invasive than others and carry a risk of pneumothorax or bleeding, which can require hospitalization (9). Preferably, the least invasive method, such as Bronchoscopy, should be used while also considering the type, location, and size of the lesion (10).
Without navigation assistance in Bronchoscopy, it can be difficult to reach the correct location for sampling, that has been identified from the CT scan, using minimally invasive techniques, and the success of the procedure is highly dependent on the operator (9). Navigation techniques are aiding the operator in locating suspicious lung lesions and, therefore, dramatically influence the diagnostic yield.
Lung lesions that are located in the more distant branches of the airways are more challenging to reach, and sampling techniques generally show a lower diagnostic yield for these locations.11 Real-time visualization during pulmonary lesion sampling can increase the diagnostic yield of the procedure (15). The use of bronchoscopes with small working channels (ie, less than 2 mm) is attractive in that they may allow the operator to reach areas of the tracheobronchial tree that are challenging with other devices; however their use may make it difficult to obtain a sufficient sample, thereby leading to a lower diagnostic yield than larger bronchoscopes (15,16).
Hence, it is very important that the physician carefully selects the appropriate configuration of bronchoscope, biopsy tool and sampling technique to obtain adequate tissue for accurate histologic and molecular characterization of the suspicious lesion. Physicians can greatly improve the diagnostic yield of the procedure when using navigation and real-time imaging of the sampling area.
Body Vision Medical offers a real-time image-guided navigation system that allows easy and accurate access to peripheral lung lesions for the diagnosis and treatment of lung cancer. LungVision has demonstrated a clinical significance of superior lesion localization correlated with increased diagnostic yield of peripheral lung lesions during navigation bronchoscopy procedures.
Depending on the technique used, the sensitivity of the test to correctly diagnose lung cancer can vary significantly, from 20% to 90% (9,11).
The technique used by the physician to obtain a sample has a major impact on the quality of the diagnosis a pathologist can provide (12). For example, in tissue fragments obtained using flexible bronchoscopy, only 1/3 of the fragment area, on average, was tissue from the suspicious lesion (13). In addition, only half of the tissue fragments obtained contained any lesion tissue at all (13).
Generally speaking, minimally-invasive techniques for endobronchial tissue sampling obtain a very small sample in comparison to surgical biopsy (8). Pathologists have a major challenge in providing a diagnosis from lung biopsies when a small amount of tissue is provided (12). In approximately 80% of patients with NSC lung cancer, physicians retrieved only a small biopsy or cytology sample to use for diagnosis (14). One of the advantages of LungVision is its ability to integrate standard pre-procedure and inter-procedure imaging with standard bronchoscopic and biopsy tools to facilitate the process of providing the optimal tissue sample for making definitive diagnosis.