Dr. Thomas Bumbalo
Pulmonologist
Grand Strand Regional Medical Center
Myrtle Beach, South Carolina
Patient Information: 65 y/o, M
Scan Protocol: Veran Inspiration/Expiration CT Scan
Nodule: RUL 23mm
Target Motion: 7.5mm
Biopsy Result: Squamous Cell Lung Carcinoma
Instruments Used: Always-On Tip Tracked® Forceps and SPiN Flex® Needle
Conclusion: Stereotactic Body Radiation Therapy (SBRT)
“This small, peripheral lesion would have been impossible to reach without navigation. The Always-On Tip Tracked® biopsy tools helped us reach this apical lesion to ultimately get an answer for this patient.”
Patient History
This 65-year-old male patient had been undergoing routine monitoring of his pulmonary nodules for five years when one began to grow. The patient was a prior smoker with COPD and asthma. Upon further testing, standardized uptake by this particular nodule was also noted and a plan was developed to sample the lesion. A navigated bronchoscopy procedure with the SPiN System® was scheduled to provide a reliable map and continuous tracking for confident sampling.
Planning
Dr. Bumbalo utilized SPiN Planning® software to segment a 23mm nodule in the RUL. Using Veran’s Gated Respiratory Scan, he was able to see the lesion was moving 7.5mm during respiration and had no visible airway directly to it. Dr. Bumbalo knew he would be relying on the system’s guidance once in the periphery of the lung to accurately line up trajectory and achieve reliable samples.
Procedure
Dr. Bumbalo began the navigational procedure utilizing a slim scope in conjunction with tip-tracked tools to successfully reach the apical segment of the RUL. Once in place, he proceeded to obtain samples with the tip-tracked serrated forceps. After several biopsies, Dr. Bumbalo used the SPiN Flex® needle to obtain additional samples of the RUL lesion. Dr. Bumbalo relied on respiratory gating and tip-tracked tools to provide continual guidance with each biopsy to obtain reliable tissue samples. The final pathology report revealed that samples obtained from navigation were consistent with squamous cell lung cancer. The patient will undergo stereotactic body radiation therapy for treatment.
