The Division of Pulmonology at Penn Medicine has introduced the Ion endoluminal system, a robotic-assisted bronchoscopy platform for minimally invasive biopsy of the lung. Situated at Penn Presbyterian Medical Center (PPMC) and Lancaster General Hospital (LGH), the Ion system will join the cone beam computed tomography program at Penn Medicine to improve biopsy precision, yield, and safety though real-time intra-procedural imaging.
The chief advantage of the Ion system is its capacity to reach and biopsy small nodules in the peripheral lung, where more than 70% of lung cancers arise. These nodules are typically beyond the reach of traditional endobronchial ultrasound (EBUS).
The Ion robotic bronchoscopy system’s thin, maneuverable catheter allows clinicians to reach small lesions in all 18 segments of the lung..
The Defining Anomaly of Lung Nodule Biopsy
Bronchoscopy for lung nodule biopsy is a time-honored method of lung cancer diagnosis, and is particularly important in the identification of early-stage lesions (Stages 1 - 2). Historically, the majority of lung cancers have been diagnosed at later stages when metastatic symptoms appear and survival is poor.
However, the defining anomaly of lung nodule bronchoscopy is that 95% of biopsied lesions will be benign, while the remaining 5% represent the world’s leading cause of cancer death. Thus, for a minority of patients, lung nodule bronchoscopy may be life-saving, but for the majority—whose nodules will never become malignant—the intervention is a source of considerable cost and great anxiety.
Introducing Ion
The goal of definitive bronchoscopic diagnosis for pulmonary nodules is safe, consistent, and high yield biopsy. Nodules in the peripheral lung are especially challenging, however, because the progressive diminishment and angulation of the branching bronchi impede the advancing bronchoscope.
“For pulmonary specialists, the effort to reach tiny nodules in the peripheral lung is difficult, time consuming, and frustrated by false negatives and other complex concerns,” says Anthony Lanfranco, MD, Director, Bronchoscopy, at Penn Presbyterian Medical Center. Reaching these nodules, he adds, is a chief advantage of the Ion Endoluminal System for robotic bronchoscopy at PPMC and LGH.
To reach small nodules in the peripheral lung, the Ion system incorporates existing patient CT scans and shape-sensing technology as guidance during the biopsy procedure, generating 3D airway trees and automatically creating a path and anatomy borders to an identified nodule.
“This pre-planned path is used to direct Ion’s robotic catheter, which can move 180 degrees in any direction and maneuver through tight turns to reach every segment of the lung,” Dr Lanfranco says.
A further innovation, Ion’s fiber-optic shape sensor measures the full shape of the catheter to provide precise location and shape information in real time throughout navigation and biopsy.
Ion Endoluminal System Research for Peripheral Lung Nodule Biopsy
The Ion Endoluminal System has been the subject of a series of clinical studies. Among these, a study presented at CHEST 2021 of Ion with or without Cone-beam CT demonstrated a diagnostic yield of 92.2% for all lesions and 89.3% for lesions <10mm (smallest = 5mm). Sensitivity for malignancy ranged from 90.4% to 91.9%.
Ion At Penn Medicine
The Penn Ion Endoluminal System program is led by Dr. Anthony Lanfranco, and includes Drs. David DiBardino, Andrew Haas, Christoph Hutchinson, and Kevin Ma. At LGH, the Ion Program is led by pulmonologists Shakeel Amanullah, MD, and Keith Beaulieu, MD. LGH was the first location in Lancaster County to introduce the Ion system, demonstrating a commitment to robotic technology that embraces the continuum from Ion bronchoscopy to robotic lung surgery.
At Penn Medicine, Ion complements the concerted efforts of the Penn Cancer program, Medical Oncology and Radiation Oncology to diagnose more lung cancers earlier through screening, and expedite the lung biopsy process for those with benign lesions. In the near future, Penn Medicine will be launching a lung cancer screening and nodule program to facilitate screening for individuals at high risk for developing lung cancer and to manage incidental findings.
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