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Navigated Bronchoscopy, SPiN Perc and Localization

RIGHT UPPER LOBE (RUL) ENDOBRONCHIAL BIOPSY
Author
Dr. Wissam Abouzgheib

Interventional Pulmonologist

Cooper University Hospital

Camden, New Jersey

Patient information: 85 y/o, M
Scan Protocol: Veran’s Inspiraton/Expiration CT Scan Protocol
Nodule: RUL <2cm
Biopsy Results: High Grade Carcinoma, Stage IA
Instruments used: Always-On Tip Tracked® Forceps, Brush, and Needle
Conclusion: CyberKnife®

Observations

“Combined with Linear EBUS, we were able to perform mediastinal staging, Navigated Bronchoscopy, Navigated TTNA, and fiducial marker placement. For this patient, a CT-guided biopsy resulting in a pneumothorax, chest tube and three day hospital admission could have potentially been avoided.”

Navigated Bronchoscopy, SPiN Perc, and Localization - Observation

Patient History
The patient was admitted to an outside hospital for dyspnea, emphysema and a 2cm lung nodule located in the RUL. A follow-up PET scan revealed the nodule was hypermetabolic and the patient was sent for a CT-guided lung biopsy. The procedure resulted in a pneumothorax requiring intervention and a three day hospital admission. The results of the biopsy were nondiagnostic.

Decision Making
Patient was discussed in the hospital’s multidisciplinary tumor board. He was deemed a poor surgical candidate, and the decision was made to treat him with CyberKnife®. The patient was then referred for a Navigated Bronchoscopy and fiducial marker placement in preparation for CyberKnife®.

Procedure
A Navigated Bronchoscopy was performed using Always-On Tip Tracked® forceps, brush, and 19ga needle. Accuracy was verified, the RUL nodule was accessed endobronchially, and biopsies were taken. Fiducial markers were loaded and deployed in adjacent tissue using the navigated needle and brush. The procedure transitioned to a navigated TTNA, SPiN Perc, using a 19ga x 105mm percutaneous Always-On Tip Tracked® needle. Three core samples were obtained during the SPiN Perc™ procedure and additional fiducial markers were placed. The total procedure time was 25 minutes with Fluoroscopy confirming fiducial placement and no complications.

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