Often when a patient has a spot or shadow on a lung scan it isn't clear what it is, said pulmonologist Carmel Joseph, who did Bissell's biopsy at Doctors.
"Probably 80 percent of the time we cannot tell just by looking at the spot whether it is a malignancy or not," he
Physicians use the patient's risk factors - whether they were smokers or had any family history of cancer - to help determine the urgency of dealing with it.
If the patient is healthy - like Bissell, a nonsmoker with no family history who stays active - and the spot is small, they might be told to get a scan in a few months to see if it has changed, Joseph
Under the old system, "we're basically hedging that it won't change and, if it changes in size, we then send a surgeon to take it out," he
"Surgeons were cutting away, in the '80s and '90s.
Where Bissell's spot sat could only be reached through surgery, Joseph
But thanks to a technique called Electromagnetic Navigation Bronchoscopy, Joseph
can be guided down to a tricky spot and hit a 3-dimensional target.
A lung CT scan is loaded into a program that then builds a 3-D model of Bissell's lungs, allowing Joseph
to do a virtual bronchoscopy, guiding to where the most suspicious spot lies.
"I've got to make this turn to get into it," Joseph
"All you have to do is miss it by a few millimeters and you've got a negative biopsy.
We just changed the whole game with this.
could then see the pathway and the imagery as a guide as he
went in to do the actual biopsy.