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Thoracic Oncology

ERS 2016 Felix JF Herth

Published Online: April 28th 2017

Felix JF Herth discusses the challenges of diagnosing lung cancer and provides an overview of the Archimedes procedure.


What are some of the clinical challenges physicians face today when diagnosing patients with lung cancer?
00:14 – So the question is where we are facing to diagnosing solitary pulmonary nodules in the future. Actually, most of our patients we see at the moment have bigger lesions, but we know that worldwide lung cancer screening by high resolution CT will be available. Doing CAT scans we will see more and more small lesions. So at the end we will see patients having a nodule of size around 1 cm. And then the question is how we diagnose those patients. All the endoscopic solutions we have at the moment failing when the nodules as smaller than 2 cm. So we have to look for new technologies which we can use, especially in the subset of patients we are finding due to lung cancer screening programmes.

How about nodules that don’t have a direct guide airway path leading to them?
01:14 – When you compare what happens to smaller nodules, when you have big lesions you always have access by an airway to the lesion. But when the nodules get smaller and smaller and smaller, the nodule is in the tissue, and not longer in the airways. When you compare it to your car, you have an address, you type the address in your GPS and the GPS tells you where to go. But when you have a big house in a big garden, the system will bring you to the street but not through the garden to the house. So when we have smaller lesions, we need some navigation support to find those small lesions within
the tissue. Therefore, we have to leave the airways and therefore we need new technologies.

How does the Archimedes procedure work?
02:07 – The Archimedes procedure has new options to diagnose more lesions, really is offering a complete new approach to coin lesions, to small lesions. What we are doing with the help of a software, we’re looking where we can open the airways to create a new tunnel directly to the lesion. So what we’re doing, we look into the CAT scan, we’re creating based on the software support, so-called point of entry. At the point of entry, we are opening the bronchial wall and then we are tunnelling ourselves directly to the lesion which offers us a possibility to diagnose small lesions, but in the future, also to treat the lesion we just diagnosed.

What do you tell your patients who go through this procedure?
03:02 – Then you have a patient in front of you with a nodule, he wants to know: How you can diagnose my nodule. As mentioned before, when you have a big nodule I can use a lot of endoscopic technologies. But when the patient is suffering on a small nodule, the only option I have is using the Archimedes system. I explain that the patient that we can do it endoscopically, that it’s a 20-minute procedure, and that we do not have any unexpected adverse event. When the patient don’t want to do that, no problem for me but then I have to send the patient to the surgeon, which have to do an open thoracotomy to the patient, which is for sure the more invasive procedure. Therefore, most of the patients, they want to have a minimally invasive procedure and therefore I have the Archimedes.

And what happens after the diagnosis?
03:51 – Actually, at the moment when we are able to establish a diagnosis, we have to think about the therapy. We have a couple of percutaneous approach technologies, we have a stereotactic radio therapy. But at the moment there’s a lot of research ongoing to offer the patient an endoscopic solution. So do the diagnosis and then after diagnosing, in the same session, doing the endoscopic treatment through the tunnel. And I’m relatively sure the initial trials are already done, that we will have endoscopic solutions for the patients in the same session. So it’s really an…in one or two years the procedure we’ll say, “I used the Archimedes to diagnose the lesion and in the same session, at the same time, I directly treat the lesion.” And everything it done endoscopically, no opening of the body, maybe one in the hospital; so really minimally invasive.

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