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Diagnosing Lung Nodules Understanding Your Options

If your physician has discovered a spot on your lung, often called a small mass or nodule, it can be a very stressful experience. Your doctor will determine if you need to have the nodule tested to find out what it is. This is called a lung biopsy. This procedure will give you the answers that you need.

Although most lung nodules are not cancer, it is important to get an early and accurate diagnosis. In the event that it is cancer, it is imperative to begin treatment as soon as possible, which will greatly improve your long-term outcomes.

There are a few different options available for diagnosing lung nodules, depending on the size and location of the nodule. Procedures and technology have evolved quite a lot over the years, so there are several options available. Here is an overview of the technology advances introduced over the last eighty years.


Transthoracic needle aspiration (TTNA) introduced in the 1940s.

Transthoracic needle aspiration (TTNA) is one of the oldest procedures available to biopsy lung nodules. During the procedure, your physician inserts a needle through the chest and into the lung to obtain a small sample of tissue from the nodule. This procedure may be recommended for nodules that are deep in the lung in hard-to-reach areas.

While TTNA is largely considered the gold standard for nodule biopsies thare are very deep in the lung, it is a more invasive procedure and carries a higher risk of complications. Complications such as a collapsed lung and internal bleeding are a significant consideration with TTNA, and as a result, this procedure is often not recommended to diagnose very small nodules.


Flexible Bronchoscopy introduced in 1968.

Flexible bronchoscopy is a procedure in which the physician manually inserts a thin tube called a bronchoscope into the lungs through the nose or the mouth. The bronchoscope has a camera on the end to allow your doctor to see inside your lungs. Flexible bronchoscopy alone is often recommended for nodules that are located in or very close to the main airways of the lungs, called the central bronchi.

This procedure has a low risk of complications, but is limited in its capabilities outside the main air passages in the lungs. For this reason, flexible bronchoscopy without any additional tools is typically not recommended to patients with smaller nodules located deeper in the lungs.


Bronchoscopy with Virtual Navigation introduced in 2003.

Virtual navigation is one of the more recent updates in the field of lung nodule biopsy, though the technology has been around for over 15 years. This procedure is similar to a traditional bronchoscopy but uses the aide of special software and additional tools to reach the nodule that is deeper in the lung. The virtual navigation software acts as a “GPS” to help the doctor guide the bronchoscope tools deep into the lungs.

Like traditional bronchoscopy, this is a minimally invasive procedure. However, the physician has limited control of the tools extended deep into the lung and no bronchoscope vision once they are deeper in the lung during this procedure. The doctor must rely on the software for guidance often making it difficulty to get a diagnosis.


Monarch Bronchoscopy: The Latest Option for Lung Nodule Biopsy introduced in 2018

The Monarch Bronchoscopy system is designed to revolutionize the way lung cancer is diagnosed (or ruled out) for patients with hard-to-reach lung nodules – even nodules that are very small (less than 1.2cm in diameter).

Like manual flexible bronchoscopy, it is also a less invasive procedure. The Monarch technology combines robotic precision, the next generation in virtual navigation software with continuous vision combined on one screen. The goal of the Monarch Platform is to provide physicians with vision and precision throughout the entire procedure.

At Auris, our goal is to help more patients get an accurate diagnosis as quickly as possible.