Small, deep lung nodules are notoriously difficult to diagnose and treat. Care typically involves separate procedures for biopsy and surgery — with a stressful wait of days or weeks in between. Many patients also undergo large resections to ensure the hard-to-reach nodule is removed.
WellSpan Health is streamlining care for these patients through real-time coordination and navigational bronchoscopy. The approach combines diagnosis and treatment in a single anesthetic session and can enable smaller, more targeted resections — thus preserving more lung function.
Nikhilesh Korgaonkar, MD, MBA, FACS
“Faster care is a huge relief for these patients. They go under anesthesia not knowing their diagnosis and can wake up already having had the cancer removed with a minimally invasive procedure,” says Nikhilesh Korgaonkar, MD, MBA, FACS, a thoracic surgeon and vice president and chief medical officer of WellSpan’s Oncology Service Line.
Streamlining the path to targeted treatment
Our pulmonologists and thoracic surgeons work side by side at the same care site, allowing them to biopsy small nodules and, when cancerous, proceed directly to surgical resection.
The coordinated approach involves these steps:
- Pulmonologists perform navigational bronchoscopy to locate the nodule and biopsy tissue. They also inject indocyanine green (ICG) dye to label the nodule for potential surgical removal.
- Pathologists rapidly evaluate tissue samples.
- If the nodule is cancerous, thoracic surgeons resect it while the patient is still under anesthesia, rather than scheduling surgery days or even weeks later.
- The ICG label enables surgeons to home in on small, deep nodules that would otherwise be difficult to find.
“The ICG dye remains visible for only a limited amount of time, so coordinating navigational bronchoscopy and surgery in one session is optimal. It not only speeds up the path from diagnosis to definitive treatment, but also allows us to remove those nodules with more precision, potentially sparing more healthy tissue,” Dr. Korgaonkar says.
Case study: More precise surgery means saving more lung function
Last year, WellSpan Health cared for a 54-year-old woman with a 4-millimeter nodule in the middle of her left lung. The nodule appeared low-risk, but the woman had a unique situation — she needed the nodule removed to get on a kidney transplant list.
The standard of care for resecting such a nodule is lobectomy, which would have removed half of the woman’s lung and potentially delayed her transplant eligibility as she recovered.
“We were able to take a far more targeted approach — the ICG label enabled us to locate the tiny nodule, and we used minimally invasive techniques to remove just a small wedge of tissue,” says Annis MB Ali, MD, a thoracic surgeon at WellSpan Health who led the woman’s surgery.
The tissue-sparing approach preserved her lung function and supported a faster recovery. She is now on the kidney transplant list.
Potentially forging the way to earlier-stage treatment
Today, WellSpan Health’s coordinated approach helps patients with small, deep lung nodules that are cancerous — or otherwise need to be removed — to get faster, more targeted treatment. As we continue to refine this approach, it may also open the door to earlier interventions for low-risk nodules that previously would have been monitored over time. The hope is that we could catch and remove more malignant nodules as early as possible while preserving more of the healthy lung tissue.