New Bronchoscope Technology Helps St. Clair Doctors Detect Lung Cancer Earlier
By Andrew Wilson
The average person might think of the lungs as a balloon, filling with air when we inhale and deflating when we exhale.
Instead of a balloon, Richard H. Maley, Jr., M.D., Chief of Thoracic Surgery at St. Clair Health, says the lungs should be compared to a different household item.
Richard H. Maley, Jr., M.D.
“The lungs are more like a sponge, with microscopic air sacs that fill up with air when we breathe,” he said. “Within those air sacs, oxygen is dissolved into the bloodstream and is replaced with carbon dioxide when we exhale.”
In most people, this complex process is taken for granted as it is repeated many times each minute – varying, of course, with each person’s current level of activity and overall fitness. In some people, however, this process can be disrupted by lung disease. There can be a problem with the blood vessels in the lungs, airways, or interstitial lung tissue. In some cases, particularly if lung cancer is suspected, a biopsy is required to determine the problem.
“There are many ways to do biopsies and all of them are useful in certain situations,” said Dr. Maley. “Only 10 percent of nodules in the lungs are cancer, - 90 percent are benign – but if there is a lung malignancy and we catch it early, we can increase their chance of survival significantly.”
One of the new tools that doctors at St. Clair Health have at their disposal is an ion robotic bronchoscope, which allows more precision in navigating through a person’s lungs. While bronchoscopes have been around for decades, Dr. Maley says the difference is the ion robotic bronchoscope allows doctors to probe further into the peripheral airways of the lungs.
“With a traditional flexible bronchoscopy, the diameter is about the thickness of your little finger. You can only probe so far into the lungs because eventually you will reach a point where the scope is jammed and it won’t go any further,” he said. “With the ion robotic bronchoscope, the scope is just a few millimeters thick so you can go into narrower airways, and with the technology that Intutive.com is calling shape-sensing technology, the computer knows exactly where the scope is. It can show the nodule and how it relates to the patient’s airways.
Such precision allows doctors to reach smaller nodules – abnormalities that may show up in imaging but are too difficult for a traditional bronchoscope to reach. If the biopsy determines that the nodule is malignant, the cancer is caught at a much earlier stage when cancer is much more curable.
“Using the shape-sensing technology offers a 90 percent chance that we will get an answer,” said Dr. Maley. “There is also a chance that as this technology improves, it will enable us to do more than diagnostics. It could also allow us to deliver therapeutics, such as freezing the lesion or implanting radiation seeds, similar to what is currently done in the treatment of prostate cancer. We’re not at that point yet though.”
Compared to other biopsy methods, patients who undergo an ion robotic bronchoscopy procedure have a lower risk of complications. Some patients report a sore throat or cough up a bit of blood the next day but usually is self-limiting. It is an outpatient procedure, but anesthesia is required so patients will need to have someone to drive them home afterwards.
“Overall, the goal is to get more accurate with these smaller nodules, and this technology helps us achieve that,” said Dr. Maley.
Richard H. Maley, Jr., M.D., is Chief of Thoracic Surgery at St. Clair Health and is board-certified by the American Board of Surgery and the American Board of Thoracic Surgery. He earned his medical degree at Hahnemann University Medical School and then completed residencies in general surgery at the University of Kentucky and in cardiothoracic surgery at UPMC. Dr. Maley also completed fellowships in trauma/critical care at the University of Kentucky and in thoracic surgery at Memorial Sloan Kettering Cancer Center, New York City. He practices with St. Clair Medical Group Thoracic Surgery and was named a Top Doctor by Pittsburgh Magazine in 2024.
Dr. Maley sees patients at the location listed below. Appointments can be scheduled by calling (412) 942-5710.:
1050 Bower Hill Road, Suite 204, Pittsburgh, PA 15243
1 Robinson Plaza, Suite 410, Pittsburgh, PA 15205