UK first robotic-assisted study to aid lung cancer diagnosis

Clinicians at Royal Brompton Hospital, part of Guy’s and St Thomas’ NHS Foundation Trust, and St Bartholomew’s Hospital are the first in the UK to use a pioneering robotic device to biopsy small and hard-to-reach lung nodules, meaning patients with suspected lung cancer could get a diagnosis much earlier.

The new robotic technology, the Ion Endoluminal System (Ion) from technology company Intuitive, allows clinicians to insert a thin and manoeuvrable catheter into a patient’s lung via their mouth to reach lung nodules suspected of being cancerous.

With Ion, clinicians can reach and sample nodules in hard-to-reach areas with greater accuracy and precision than existing techniques, so that nodules which may otherwise have been monitored for long periods can be definitively diagnosed earlier via biopsy.  

This minimally invasive approach reduces the risk for patients compared to other existing biopsy techniques where a needle would be inserted from outside the body into the lungs.

Teams from the London hospitals are participating in a clinical study which aims to determine how the technology could best help patients by diagnosing cancers at an earlier stage and benefit the NHS by increasing the number of diagnostic procedures hospitals are able to carry out. Each hospital in the study will recruit around 50 patients with small lung nodules detected on computerised tomography (CT) scans in difficult to reach areas of the lungs.

Lung cancer is the most common form of cancer death in the UK with more than two-thirds of cases being diagnosed at a late stage of progression. An expanding national screening programme in England will mean that all current and former smokers between 55 and 74 years old will be assessed and invited for lung cancer screenings. NHS England is aiming to reach a 100% coverage of the population by March 2030.

Professor Pallav Shah, consultant respiratory physician based at Royal Brompton Hospital, said: “The expanding national lung cancer screening programme in England will increase the number of suspicious nodules detected on CT scans at an earlier stage which will need to be biopsied to determine a diagnosis.

“We know that an earlier diagnosis of lung cancer leads to significantly improved outcomes for our patients. When we see patients with cancerous lung nodules of more than 30mm, their five year survival rate is around 68%, but if we are able to detect these nodules at a smaller size, when they are less than 10mm in size, we are looking at a 92% survival rate.

“This new technology is transformative for us as clinicians because it allows us to access and biopsy nodules of less than 10mm in size in difficult to reach areas of the lungs. The chance of a cure for these patients is therefore vastly improved.”

With this technology, clinicians are also able to access areas of the lungs which would have previously been hard to reach with existing tools due to either the depth of the nodule within the lungs or the tortuous route to reach them.

Mr Kelvin Lau, consultant thoracic surgeon for St Bartholomew’s Hospital, said: "The UK is leading the world in rolling out a national lung cancer screening programme. However, only some of the lung nodules identified during screening are cancerous and need treatment. Current biopsy techniques carry risk and are not always accurate, and many patients end up waiting for a repeat scan. The uncertainty of the wait causes anxiety and could allow a cancer to grow and spread.

“With this shape-sensing robotic technology, I have the precision and stability to lock onto a very small lung nodule and obtain an accurate biopsy quickly and safely. This could transform early diagnosis and treatment, reduce the need for repeat scans and treat lung cancer earlier.”

Charlie Dean, Senior Vice President and General Manager of Endoluminal at Intuitive said: “We’re delighted to be working with clinicians in the UK to demonstrate the value that Ion could bring to the overall lung cancer patient pathway. The healthcare system in the UK is a hub of innovation and Ion’s entry here will be an important first step to wider patient access in Europe. 

“With plans underway for the UK’s first targeted national lung cancer screening programme, improving the early diagnosis of cancers is rightly a top priority. We hope that our Ion platform can play a role in delivering the ambitions set out when it comes to earlier diagnosis and better outcomes for patients in the UK and beyond.”