J. Matthew Reinersman, MD, FACS
Assistant Professor
Division of Thoracic and Cardiovascular Surgery
University of Oklahoma Health Sciences Center
Oklahoma City, OK
Patient Information: 73 y/o, F
Scan Protocol: Veran Inspiration/Expiration CT Scan Protocol
Nodule: RLL 20mm
Target Motion: 14mm
Biopsy Result: Neuroendocrine Hyperplasia
Instruments Used: Always-On Tip Tracked® Triple Needle Brush, 21ga Needle, & Brush
Conclusion: Routine Follow-up
“This was our initial experience with the Always-On Tip Tracked® Triple Needle Brush. The visualization of the instrument and vasculature on SPiN Drive® allowed for the accurate biopsy and diagnosis of this right lower lobe nodule.”
Patient History
This 73-year-old female patient presented with a history of smoking and multiple solid nodules bilaterally concerning for diffuse idiopathic neuroendocrine cell hyperplasia (DIPNECH). She was referred to Dr. Reinersman for biopsy of a right lower lobe nodule. He opted to utilize the SPiN Thoracic Navigation System® for a minimally-invasive approach to biopsy the nodule with an endobronchial approach.
Planning
A same-day Inspiration/Expiration CT scan was performed using Veran’s CT protocol. Dr. Reinersman utilized the SPiN Planning® software to segment a right lower lobe nodule. The SPiN Planning® software revealed that the nodule was 20mm in size and moving 14mm during respiration.
Procedure
Dr. Reinersman started the procedure with navigation. He was able to reach the area of interest utilizing a slim scope in conjunction with tip-tracked instruments. He first obtained samples utilizing the tip-tracked brush. Dr. Reinersman then opted to utilize the tip-tracked triple needle brush to sample the right lower lobe nodule. Rapid On-Site Evaluation (ROSE) noted atypical cells with neuroendocrine features from the passes with the tip-tracked triple needle brush. Dr. Reinersman obtained additional tissue using the tip-tracked 21ga needle for cell block. The final pathology report revealed that collected samples were morphologically consistent with neuroendocrine hyperplasia suggestive of DIPNECH. The case was reviewed at the multidisciplinary tumor board and the recommendation was for serial observation with medical oncology.
