UCLA Combines Lung Cancer Diagnosis and Surgery Into One Session

For patients with early-stage lung cancer, the path from a suspicious finding to treatment can normally take weeks or months. It is spread across separate biopsies, staging tests, tumor-locating procedures and surgery. Doctors at UCLA Health have now adopted a streamlined approach that combines all four steps into a single operating-room session under one anesthetic. For selected patients, what once took weeks can now take a matter of hours.

"Among the strongest arguments for this approach are recent studies showing that delays between the identification of early-stage lung cancer and surgery can worsen outcomes," said Bryan Burt, professor and chief of thoracic surgery at UCLA and an investigator at the UCLA Health Jonsson Comprehensive Cancer Center. A study led by a UCLA surgery resident found the median time from identifying a suspicious lung nodule to surgery was 57 days, ranging from 41 to 79 days, and that patients whose wait exceeded eight weeks had lower survival and higher recurrence. A separate study of patients in the U.S. Veterans Affairs health system found an average wait of about 70 days from diagnosis to surgery, with survival again dropping once the interval passed 12 weeks.

In the new approach, a carefully evaluated patient undergoes four steps during one session. First, robotic bronchoscopy biopsies the suspicious lung nodule, which pathologists evaluate in real time. Second, endobronchial ultrasound biopsies lymph nodes in the chest to check, also in real time, whether the cancer has spread. Third, doctors place a small marker called a fiducial into or near the nodule to help the surgeon locate it precisely. Fourth, if the cancer is confirmed to be early-stage, the surgeon proceeds directly to robotic surgery to remove it.

"Traditionally, patients may go through several appointments and procedures over a period of weeks to months," said Reza Ronaghi, an interventional pulmonologist and critical care physician at UCLA Health. "With this approach, that process can potentially be condensed into a single three- to four-hour episode of care." Beyond saving time, Ronaghi said, the approach can also reduce the anxiety patients feel while waiting between a suspicious scan, a biopsy, staging and treatment.