For the millions of patients with complex lung and chest conditions, hope arises from an emerging medical field known as interventional pulmonology, which focuses on using minimally invasive approaches to diagnose and treat advanced cases. Although it is a relatively new medical subspecialty, at the University of Colorado Anschutz Department of Medicine, patients are already seeing the benefits thanks to the leadership of Ray Parrish, MD, the associate director of interventional pulmonology at CU Anschutz.
Through his innovative work, Parrish is helping patients avoid unnecessary open surgeries, get diagnoses faster, and receive potentially life-saving treatments. He is also unlocking access to areas of the chest that were previously inaccessible, enabling more patients to get the answers and care they need.
His work primarily focuses on using robotic bronchoscope tools to reach into the chest in a minimally invasive way to investigate concerning nodules or suspected tumors. Through this approach, he can diagnose rare infections or conditions, and if cancer is detected, he can often determine the stage of the cancer at the same time, eliminating what sometimes requires multiple procedures.
Robotic bronchoscope tools are thinner and computer-guided, allowing physicians to reach farther through the airways into the deep and outer areas of the patients’ lungs. While earlier bronchoscopes required a steady hand and had a limited range, this advanced technology enables minimally invasive techniques to reach almost anywhere in the chest.
“We can get there,” says Parrish, an assistant professor in the CU Anschutz Division of Pulmonary, Allergy, and Critical Care Medicine. “If there is a tumor, or scar tissue, or narrowing of the airway, there’s almost always the chance that we can do something about it.”
When it comes to airway conditions — such as tumors or narrowing due to autoimmune conditions — interventional pulmonology offers multiple treatment options.
For example, Parrish may use minimally invasive approaches to remove scar tissue, eliminate tumors, or place stents in the chest to help patients breathe more easily. Data has also shown that the techniques Parrish uses lead to fewer adverse effects than more invasive approaches, he explains.
Another unique approach is the application of microwave energy to ablate, or remove, problematic areas in the airways, such as tumors, by inserting a probe directly inside the tumor.
This technique may have fewer adverse effects compared to radiation treatment, Parrish explains. Traditionally, radiation treatment is applied externally and passes through healthy tissue to reach the tumor, which can affect other parts of the body. By delivering the microwave energy directly to the tumor from within, this newer approach may help limit exposure to surrounding tissues and reduce negative side effects.
He is working on research to evaluate the efficacy of applying microwave energy directly on lung nodules or tumors in the lungs, aiming to advance care for more patients.
Interventional pulmonology is also unlocking hope for patients with lung cancer, which is the second most common cancer in men and women in the U.S.
Primarily affecting those who are 65 and older, lung cancer is “by far the leading cause of cancer death,” according to the American Cancer Society. Patients often do not experience symptoms or receive a diagnosis until it has reached an advanced stage, underscoring the importance of early detection.
An ongoing challenge is when a lung nodule or tumor is in an area that is difficult for physicians to reach with traditional bronchoscopy procedures. As a result, many patients in these circumstances traditionally needed open surgery or a needle inserted deep into the chest from the outside, options that carry far greater risks of complications and may be unsafe for some patients.
Minimally invasive methods used by interventional pulmonologists, however, allow physicians to diagnose and stage these hard-to-reach tumors, potentially giving patients more options with lower complication rates and better outcomes.
“By catching things earlier and more comprehensively determining where things stand, that shifts the paradigm,” Parrish says.
Parrish has seen several patients who have been told by other doctors that nothing more can be done. One male cancer patient, for instance, visited five different hospitals before connecting with Parrish. The patient's trachea had been compressed to just 2 millimeters — compared with its normal width of about 20 millimeters — making it difficult for him to breathe and preventing him from continuing cancer treatment. Parrish performed a rigid bronchoscopy to dilate the trachea to 16 millimeters and placed a stent to hold the airway open. The procedure allowed the patient to resume receiving cancer-directed therapy and return to activities he was passionate about, including rebuilding cars and golfing.
“He is still alive today and is now getting his cancer treatment because my team and I were able to help him,” Parrish says. “And that’s not just because of me. It’s the team and the equipment this hospital can provide so that we can perform these procedures and offer these options to patients.”
Interventional pulmonology is relatively young in the medical world, having developed over the past 20 years. Parrish discovered the field as an internal medicine resident at Massachusetts General Hospital, where he witnessed a robotic bronchoscopy being performed for the first time.
“It was such a radically big improvement on where it could reach in the chest, allowing for a more comprehensive offering for patients to diagnose and stage cancer in the same procedure in a very high-fidelity way,” Parrish says. “That was the very beginning of my journey in this field.”
Now a leader in the field at CU Anschutz, patients from across the country have traveled to see Parrish. He explains that interventional pulmonologists with his capabilities are still relatively uncommon, and physicians in other specialties may not always be aware of the full range of what can be done.
Hoping to change that, Parrish is working to develop and expand a strong team of interventional pulmonologists at CU Anschutz who can offer these services to more patients. He recruited Anthony Lanfranco, MD, to become the division’s director of interventional pulmonology, and the pair are now offering services at both the CU Anschutz campus and UCHealth Highlands Ranch Hospital.
“It takes a village,” Parrish says. “Together, we’re making big advancements.”