Diagnosis Achieved After Non-Diagnostic CT-Guided Biopsy

Patient History
This 36 year-old female with a history of breast cancer was hospitalized after undergoing an attempted CT-guided biopsy. This CT-guided procedure resulted in a pneumothorax and a vasovagal response of the patient. The 14mm nodule located in the Right Lower Lobe (RLL) was PET positive and CT scans revealed that the nodule increased in size. The physician suspected malignancy due to the patient’s history of triple-negative breast cancer despite no other risk factors associated with lung cancer.

Planning
A same-day Inspiration/Expiration CT scan was performed using Veran’s CT protocol. SPiN Planning^® was used and determined that this 14mm nodule in the RLL was moving 9mm between respiratory phases. Upon examination of the CT scan, Dr. Chbeir noticed that there was no direct airway leading to the target. He then opted to utilize the SPiN Xtend^® alternate planning feature to exit the airway utilizing the 21ga SPiN Xtend^® needle during the procedure. The distance between this exit point and the nodule was 19.2mm.

Procedure
The physician was unable to reach the nodule using Always-On Tip Tracked® serrated forceps and the 21ga needle due to lack of a bronchus sign. He decided to use the SPiN Xtend^® needle and successfully navigated to the exit point set during the planning portion of the procedure. The physician was able to successfully align the trajectory of the needle and set the throw to 30mm in order to obtain biopsies. Malignant cells were noted upon inspection of the first pass with the SPiN Xtend^® needle and additional samples were taken.