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Accurate Localization Helps Confirm Metastatic Diagnosis

Dr. James Lubawksi M.D.

Thoracic Surgeon

Edward Hospital

Naperville, IL

Patient Information: 49 y/o, M

Scan Protocol: Veran Inspiration/Expiration CT Scan

Nodule: RUL 6mm

Biopsy Result: Malignant

Instruments Used: Always-On Tip Tracked® Guidewire, SPiN Perc® 1cm Localization Needle

Conclusion: Metastatic Colon Cancer


“By using the Veran system for thoracic localization, I am able to find much smaller nodules and take them out in smaller wedges of lung all while cutting down on operative time.”

Patient History
This patient with history of smoking was previously diagnosed and treated for colorectal cancer. During a routine follow-up CT scan, a few small lung nodules were discovered, including a 6mm nodule in the right upper lobe. The patient’s physician care team suspected metastatic colon cancer and needed to get a diagnosis to immediately begin a treatment plan. Dr. Lubawski, thoracic surgeon, decided to proceed with a surgical biopsy due to the nodule’s small size and peripheral location. As he knew he would not be able to palpate the nodule, Dr. Lubawski planned to use Veran for localization in order to identify the nodule.

The patient was scanned in the lateral decubitus position using Veran CT scan protocol in order to further streamline localization and resection. The patient would already be in operative position when the localization was complete. Upon reviewing the CT scan the surgeon identified and segmented the 6mm nodule with Veran SPiN Planning® software. Dr. Lubawski planned a trajectory to reach the nodule percutaneously using the SPiN Perc® 1cm Localization Needle.

Dr. Lubawski first used the Always-On Tip Tracked® Guidewire to perform a quick endobronchial registration with the patient in the lateral decubitus position, already positioned for surgery. The procedure then transitioned to SPiN Perc® for percutaneous localization. Dr. Lubawski lined up his trajectory and advanced the needle to the targeted peripheral nodule. Visualizing the needle’s marking zones on the Veran system, he injected 0.6cc of dye into the nodule. This localization process took a total of 8 minutes, and the procedure transitioned to VATS resection. The dye marking was clearly seen on the nodule, as well as a trail to the chest wall where Dr. Lubawski had advanced the needle. Upon wedge resection, pathology confirmed an accurate marking of a malignant nodule. Final pathology revealed metastatic colon cancer. The accurate localization and diagnosis of the nodule allowed the patient care team to immediately plan treatment.

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