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Navigation Helps Get an Answer

NAVIGATION HELPS GET AN ANSWER
Author
Dr. Brian Furukawa

Pulmonologist

Loma Linda University Medical Center

Loma Linda, California

Patient Information: 81 y/o, F

Scan Protocol: Veran’s Inspiration/Expiration CT Scan Protocol

Nodule: LUL 26mm

Biopsy Results: Squamous Cell Carcinoma

Instruments Used: Always-On Tip Tracked® Forceps, Brush, Needle, and SPiN Perc™

Conclusion: Stage IIIA NSCLC

Observations

“Obtaining the tissue diagnosis (as well as safety) is the most crucial aspect of the procedure. Having multiple avenues in which to do that increases the chance of success all that much more. This is especially realized in an era where treatment is based on more than just histology but genetic make-up, which means additional tissue will be needed to run all appropriate tests.”

Patient History
An 81 year-old female former smoker with multiple comorbidities presented with a LUL nodule that had been followed for years. A previous IR CT guided biopsy showed interstitial fibrosis. After continuing to grow slowly, she was sent to Pulmonology for further evaluation.

Planning
A vPad™ was placed, and the patient underwent the Veran inspiration/expiration CT scan protocol. The 2.6cm nodule in the LUL was automatically segmented using the SPiN Planning™ software. The nodule had increased in size from 2.0cm when it was first biopsied by IR.

Procedure
The field generator was positioned over the vPad™ and the patient was automatically registered. Dr. Furukawa verified registration accuracy and then navigated out to the target. An EMN guided bronchoscopy was performed and multiple biopsies were taken via Always-On Tip Tracked® brush, needle, and forceps with confirmation of a concentric view on R-EBUS. No ROSE was available, therefore Dr. Furukawa seemlessly transitioned to SPiN Perc™. Of the endoscopic biopsies only transbronchial forceps biopsies were positive for malignancy. The core samples taken with TTNA were also positive for Squamous Cell Carcinoma. The PET/CT scan showed a level 5/6 lymph node with significant interval enlargement and PET avidity. The patient was not fit to undergo surgical biopsy, and therefore her stage was deemed to be IIIA, and she was treated with definitive chemotherapy and radiation.

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