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Physician’s First Veran Procedure Diagnoses GGO

RIGHT MIDDLE LOBE (RML) ENDOBRONCHIAL BIOPSY
Author
Dr. Da-Wei Liao

Pulmonologist

Banner University Medical Center

Phoenix, Arizona

Patient information: 71 y/o, M
Scan Protocol: Veran’s Inspiration/Expiration CT Scan Protocol
Nodule: 14mm GGO RML
Target Motion: 3.0cm
Biopsy Results: Pulmonary Adenocarcinoma
Instruments Used: Always-On Tip Tracked® Forceps & Brush
Conclusion: Surgical Resection

Observations

“While the nodule was difficult for my first Veran procedure, the system was intuitive and easy to use. The GGO nodule would not have been visible under fluoroscopy, so I could not have done the procedure without navigation.”

Utilizing Veran’s TargetLock Ensures Diagnosis on GGO Observations

Patient History

The patient was a 71 year-old male with a history of smoking. Due to his lengthy smoking history and other contributing high-risk factors, the patient was advised to get a chest CT. The CT revealed a 14mm Ground-Glass Opacity (GGO) nodule in the Right Middle Lobe (RML).

Planning

The pleural based nodule was located in the RML without a direct bronchus sign. A sphere was placed on the GGO nodule marking where the biopsy would take place. The nodule was also sitting on a fissure, so precision was crucial. Veran’s Inspiration/Expiration CT Scan Protocol revealed 3cm1 of movement, over twice the nodule’s diameter. A plan was created to biopsy the nodule endobronchially. Due to the location and lack of bronchus sign, the decision was made to biopsy the lesion endobronchially with the possibility to convert to SPiN Perc; therefore a second plan was created.

Procedure

Navigation began with a main carina verification using the Always-On Tip Tracked® forceps. With ease, the nodule was reached within 2 minutes. Due to 3cm of nodule movement, it was imperative to monitor the respiration of the patient. The respiratory gating on the system ensured the tissue was diagnostic, without the need for fluoroscopy. Pathology reports showed Adenocarcinoma. The patient underwent a RML lobectomy.

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References
  1. The Effect of Respiratory Motion on Pulmonary Nodule Location During Electromagnetic Navigation Bronchoscopy: Chen et al;Chest. 2015;147(5):1275-1281: May 2015, vol 147, No. 5

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