Minimally Invasive Procedures Allow Pulmonologist to Diagnose/Stage Chest Diseases with Higher Accuracy, Fewer Risks

Michael Pritchett, D.O.

PINEHURST – Just two years ago, Brenda Smith would have needed a surgery performed under general anesthesia to determine the cause of the enlarged lymph nodes in her chest.

Instead, in June 2010, she became one of the first patients at FirstHealth Moore Regional Hospital to have a minimally invasive procedure called Endobronchial Ultrasound (EBUS).

Performed by pulmonologist Michael Pritchett, D.O., of Pinehurst Medical Clinic, the procedure was done in the hospital’s Outpatient Center and took about 45 minutes while Smith was sedated but responsive. The now 60-year-old Smith was back at her job as a Moore Regional switchboard operator the next day, and she had a diagnosis – sarcoidosis, a chronic lung condition but not the cancer she had feared – by the end of the week.

“Dr. Pritchett told me I would be a good candidate for (EBUS), because it is less invasive,” Smith says “It was a very easy procedure, and I had no side effects.”

A $235,000 disbursement from the Moore Regional Hospital Foundation in February 2010 allowed the hospital to acquire the state-of-the-art technology used in Smith’s procedure. Since that time, Dr. Pritchett has done more than 150 EBUS procedures, using the technology to diagnose and stage diseases of the chest by accessing lymph nodes that previously would have been reached only by surgical means – if at all.

“This gets into places that previously were not accessible at all or were risky to get to,” Dr. Pritchett says. “It’s safer, less invasive and more accurate.”

EBUS begins when the physician inserts a small scope into the lungs through the patient’s mouth. After the scope is in place, a special ultrasound probe that is incorporated into the scope sends sound waves through the walls of the airways into the various lymph nodes in the surrounding areas.

When an enlarged lymph node is located, the physician takes a tissue sample (or biopsy) with a small ultrasound-guided needle. The procedure allows safe and accurate real-time sampling of lymph nodes that are as small as 5mm as well as those located near major blood vessels, such as the aorta or pulmonary arteries.

“We look at all the lymph node stations that we are able to reach,” Dr. Pritchett says. “When we are staging (cancer), we try to biopsy as many lymph node stations as possible. This ensures accurate staging, which in turn determines the patient’s prognosis and treatment options.”

Unlike the “gold standard” mediastinoscopy, a surgical procedure for the diagnosing and staging of lung cancer and other diseases of the chest that involves an incision just above the breastbone, the procedure eliminates complications such as collapsed lung, bleeding or the risks of general anesthesia.

According to Dr. Pritchett, accuracy rates with the new technology are high – 85 to 95 percent with EBUS alone or nearly 100 percent when used in conjunction with Endoscopic Ultrasound (EUS) to stage lymph node involvement in various cancers. EUS is a similar procedure (done through the esophagus) that is performed at Moore Regional by gastroenterologist Eric Frizzell, M.D., also of Pinehurst Medical Clinic.

Dr. Pritchett describes EBUS as a valuable tool in the diagnosis and staging of various cancers but most commonly for lung cancer. More than half of the people with lung cancer die within one year of being diagnosed, because 75 percent of those cases are diagnosed at an advanced stage (III or IV).

The number-one cause of cancer-related death, lung cancer kills more people than breast, prostate, colon and pancreatic cancers combined. If diagnosed at Stage I, the lung cancer survival rate at 10 years is 88 percent. If diagnosed at Stage III or IV, however, the survival rate drops significantly (to just 15 percent at five years).

With immediate removal of an early-stage cancer lesion, there is a 92 percent survival rate, says Dr. Pritchett.

Dr. Pritchett, who is medical director of Moore Regional’s Chest Center of the Carolinas, also uses Electromagnetic Navigational Bronchoscopy (ENB) to improve early diagnosis lung cancer and other diseases of the chest. ENB is a GPS-like tool that employs a three-dimensional image created from the patient’s own CT scan to guide a steer-able catheter into the distant areas of the lungs. The procedure can be used to reach very small lesions that would otherwise require an invasive procedure for diagnosis.

Dr. Pritchett used ENB to diagnose the lung cancer of Foxfire resident George Galloway. Galloway had a 13mm spot on his lungs in an area that would have otherwise been accessible only with an invasive surgical procedure requiring general anesthesia and a large incision between the ribs.

After Dr. Pritchett diagnosed his cancer at an early stage, Galloway had chemotherapy and radiation treatments. He now has monthly follow-ups with his medical and radiation oncologists, but hasn’t needed further treatment.

“It was still mighty small,” Galloway says of the cancerous spot. “That’s why it was such a problem to find the thing.”

The 87-year-old Galloway, a retired AT&T electrical engineer, says he slept throughout his ENB and was “in and out” of the hospital the same day.

“I woke up, and I was done,” he says. “I didn’t feel a thing.”

Moore Regional is the only hospital in its 15-county service area to offer EUS, EBUS and ENB. Dr. Pritchett is currently the only physician at Moore Regional to provide EBUS and ENB, although other physicians are now being trained to perform EBUS.

“We want to stay abreast of the most current technologies and utilize them in the care of our patients to get the best and most accurate diagnoses,” Dr. Pritchett says.

“EBUS and electromagnetic navigational bronchoscopy allow us to be on the cutting-edge of the diagnosis and staging of diseases of the chest. These technologies are safer and less invasive than current strategies and allow for more accurate staging and earlier diagnosis.”

The Chest Center of the Carolinas is a multidisciplinary group of seven different medical and surgical specialties that focuses on the treatment of various diseases of the chest. The group meets weekly to review cases, make recommendations and coordinate care. For more information on its services or the EBUS, EUS and ENB technologies, call (800) 213-3284.