By: Dominique J. Pepper, M.D. M.B., Ch.B. M.H.Sc
Medical Director for Bronchoscopy and Respiratory Care
Providence St. Peter Hospital
Lung cancer kills more people each year in the United States than breast cancer, colon cancer and prostate cancer combined. Lung cancer deaths occur mostly in those with later stage (III and IV) disease, so early detection of early-stage (I and II) lung cancer is key to curing lung cancer and improved survival.
In October 2022, Providence St. Peter Hospital revitalized its lung nodule program to expedite lung cancer diagnosis and treatment. We utilized a four-pronged strategy including:
i) Enhanced lung nodule surveillance;
ii) Creating a dedicated pulmonology lung nodule clinic;
iii) Allocating dedicated bronchoscopy days for lung biopsies; and
iv) Leveraging the Ion robot-assisted bronchoscopy platform, known as the Ion, to biopsy lung nodules as small as 8mm in size (1/3 inch) to diagnose early lung cancer.
This was only possible with the Providence Southwest Washington Foundation, which secured a $100,000 gift that created a trial period for the Ion.
Over the last 6 months, we have witnessed incredible progress in our fight against lung cancer. We shortened the time to initial pulmonology assessment from 13 to eight days and halved the time to diagnostic biopsy from 42 to 20 days. We increased both the number of bronchoscopies performed per month (from 31 to more than 50), and the number of lung cancers diagnosed each month (from 15 to more than 25). Utilizing the Ion, we are now diagnosing much smaller lung cancer nodules (as small as 7mm in size, as opposed to 20mm using conventional technology) and we are increasing the proportion of early-stage lung cancer cases (from 34% to 47%) that are curable. We have also observed the number of patients undergoing curative thoracic robotic lobe resections each month doubling after introduction of the Ion.
The Ion has several novel components that ensure its success. Its robotic shape-sensing catheter combined with its state-of-the-art mapping software allows precise localization of both peripheral and central lung cancer nodules. In one procedure, we can now both diagnose and stage lung cancer, thus shortening the time interval to definitive treatment. Diagnostic yield with the Ion is 80% to 85% and there are minimal complications (less than 2% pneumothorax rate), especially as the software program clearly delineates the pleural border of lung during the procedure.
We are encouraged by our progress thus far, and know we still have considerable work to do. In the next few months, we plan to combine our Ion robotic bronchoscopy procedures with mobile cone beam CT. One important challenge we encounter when performing diagnostic robotic bronchoscopies is CT to body divergence. During divergence, the cancerous lung nodule seen on the pre-procedure CT scan differs in location to its actual location during the procedure (by up to 2 cm or an inch in distance) due to the patient’s breathing patterns. The best solution to this challenge is to use real-time cone beam CT imaging during the procedure to precisely locate the cancerous lung nodule after navigating to the target with the Ion. With mobile cone beam CT, we will increase our diagnostic yield to 95% and diagnose an additional 15 to 25 early-stage lung cancers each year.
Referral Information
To refer patients, please use one of the following options:
- Order a referral to "PMG SW WA Pulmonary and Sleep Medicine" listing lung nodule or lung mass as the diagnosis and marking the referral as urgent (preferred method)
- Fax urgent referral to 360.412.6474 marked "Urgent Lung nodule"
- Email the patient information to dominique.pepper@providence.org (marked *confidential*)
- EPIC secure chat (Dominique J Pepper)
More about Dr. Pepper
Dr. Dominique J. Pepper is a pulmonary disease specialist. He graduated with honors in 2004 and trained at the National Institutes of Health and the University of Maryland Medical Center. Dr. Pepper has more than 15 years of diverse experience and is board certified in pulmonary disease, critical care and internal medicine.
Photo Information
Photo 1: Ion-robot assisted bronchoscopy platform, Photo 2: Cios Spin Siemens mobile cone beam CT, Photo 3: Ion Navigation software, Photo 4: Ion controller
