Advanced lung cancer diagnostics with robotic bronchoscopy
When imaging reveals a suspicious lung nodule, advanced diagnostic tools can help determine what comes next. UI Health Care combines robotic bronchoscopy, specialized expertise, and multidisciplinary care to diagnose difficult-to-reach lung nodules safely and precisely.
- Robotic bronchoscopy helps physicians reach and biopsy small or difficult-to-access lung nodules through a minimally invasive approach using the patient’s natural airways.
- Diagnosis and lymph node staging can often happen during the same procedure, potentially reducing the need for additional procedures and shortening the time to treatment.
- Tissue collected during a biopsy can support molecular and biomarker testing, which helps medical specialists personalize lung cancer treatment.
- UI Health Care uses a multidisciplinary approach, bringing together cancer specialists in pulmonology, radiology, pathology, thoracic surgery, medical oncology, and radiation oncology.
- Expanded expertise and advanced technology are strengthening UI Health Care’s ability to determine whether suspicious lung findings need treatment, biopsy, or continued monitoring.
Does a spot on a lung scan mean lung cancer?
A suspicious spot on a lung scan does not necessarily indicate lung cancer. At University of Iowa Health Care, specialists use advanced diagnostic tools, including robotic bronchoscopy, to help determine what a lung nodule is and whether it needs biopsy, treatment, or continued monitoring.
This is a key focus for UI Health Care pulmonologists Robert Smyth, MD, and Abbie Begnaud Muckler, MD, who evaluate patients with unusual or concerning findings on chest imaging.
“Our specific expertise is figuring out — with the help of the multidisciplinary team that we work with — if an area is concerning,” Begnaud Muckler says. “Is it something that needs a biopsy, or is it something that we can safely watch?”
How robotic bronchoscopy reaches difficult lung nodules
Lung nodules are small masses of tissue in the lung that can be caused by scarring, infection, previous injury, and other noncancerous conditions. Small nodules near the outer edges of the lungs have traditionally been challenging to biopsy. One option to evaluate lung nodules is a CT-guided lung biopsy, which requires a needle to pass through the skin, between the ribs, and into the lung. This approach can carry risks, including bleeding and pneumothorax, also known as lung collapse.
Robotic bronchoscopy takes a different route.
UI Health Care uses the minimally invasive Ion robotic bronchoscopy platform. With the patient under general anesthesia, physicians guide a thin robotic catheter through the patient’s airways along a predetermined path toward the suspicious nodule.
Begnaud Muckler compares the navigation to turn-by-turn directions. The bronchial tree contains hundreds of branches and turns, and the robotic platform helps the physician navigate those increasingly small pathways toward the targeted area.
Once there, the robotic bronchoscopy system can:
- Hold the catheter in position with a high degree of precision
- Reach far into the peripheral areas of the lung
- Allow the physician to adjust for the best angle to the targeted nodule
- Provide a stable pathway for biopsy instruments to reach the lesion
Stability is particularly important when physicians are trying to collect tissue from a very small target.
Without robotic assistance, “It’s truly like trying to find a needle in a haystack,” Begnaud Muckler says.
Because robotic bronchoscopy reaches the nodule through the patient’s natural airways rather than through the chest wall, it can reduce the risk of complications such as bleeding and pneumothorax compared with CT-guided biopsy.
UI Health Care’s robotic program has been operating since 2023 and continues to expand, with the goal of making this minimally invasive diagnostic option available to more patients.
One procedure can provide diagnosis, staging, and treatment information
The value of robotic bronchoscopy extends beyond determining whether a lung nodule is cancerous.
During the same procedure, pulmonologists can examine and sample lymph nodes in the center of the chest. If lung cancer is diagnosed, knowing whether it has reached those lymph nodes helps physicians determine the cancer stage. This information can directly affect treatment.
A patient whose lymph nodes do not show signs of cancer may potentially move toward surgery. Cancer found in those lymph nodes may require a different treatment approach.
Gathering this information at the time of diagnosis may also eliminate an additional procedure.
“If we can tell a surgeon that the lymph nodes are not involved, then we don’t have to do a second procedure to prove that to them before they go to surgery,” Smyth says.
Obtaining enough high-quality tissue is also increasingly important because lung cancer treatment is becoming more personalized.
Molecular and biomarker testing can identify characteristics of a tumor that may affect decisions about immunotherapy, targeted therapies, surgery, or other treatments. Smyth says biomarker testing, once primarily used for advanced-stage disease, is increasingly informing care at earlier stages, as well.
Pathologists can also review samples in real time during the procedure and provide feedback about the tissue physicians collect.
Multidisciplinary expertise helps guide the next step
Robotic technology is only part of the diagnostic process.
UI Health Care’s approach brings together specialists in pulmonology, radiology, pathology, thoracic surgery, medical oncology, and radiation oncology.
The team holds a weekly meeting, known as a lung cancer tumor board, to discuss patient cases. Collaboration happens outside those meetings, as well. Specialists communicate directly about patients, coordinate procedures, and anticipate what other members of the care team will need to make treatment decisions.
For Begnaud Muckler, it’s thinking beyond simply obtaining a biopsy.
“We are thinking two or three steps ahead of what this person needs to get to whatever their next steps are going to be,” she says.
Research shows that patients can benefit when specialists from different areas work together. A 2023 review found that people with non-small cell lung cancer who received care from a multidisciplinary team tended to live longer, start treatment sooner, and were more likely to receive complete staging than those who did not.
For patients, this type of coordination can create a more connected path from a suspicious scan to diagnosis, staging, and ultimately treatment.
Building the future of lung cancer diagnosis and treatment
UI Health Care is continuing to look for ways to make lung cancer diagnosis even more precise.
Smyth says the team is working toward additional advanced imaging capabilities that could further improve its ability to accurately biopsy suspicious nodules.
The future of robotic bronchoscopy may also extend beyond diagnosis.
Technologies in development could eventually allow physicians to navigate to a suspicious lung nodule, diagnose the cancer, and treat it during the same procedure.
“Not only will you diagnose the cancer,” Smyth says, “but there’s also going to be an opportunity to intervene at the same time.”
For now, the program gives patients and referring clinicians access to a specialized team that can help answer the essential question after an abnormal scan: What is this finding, and what should happen next?
“Just because you have a nodule doesn’t mean you have lung cancer,” Smyth says. “We’re here to provide an expert, multidisciplinary assessment to help you figure that out.”
