Dr. Devin Sherman
Pulmonary Disease
Williamson Medical Center
Franklin, TN
Patient Information: 82 y/o, F
Scan Protocol: Veran Inspiration/Expiration CT Scan Protocol
Nodule: RUL 47mm
Biopsy Result: Malignant
Instruments Used: Always-On Tip Tracked® Serrated Forceps, 21g Needle & SPiN Perc®
Conclusion: Non-small cell adenocarcinoma, fiducial marker placement for SBRT
“We were able to successfully obtain biopsies with an endobronchial approach, but having the ability to easily transition to SPiN Perc® gave us the confidence to obtain a diagnosis during the procedure.”
Patient History
This patient was admitted to Williamson Medical Center 6 weeks prior to procedure with pneumonia, and imaging discovered a lesion in the RUL. After a round of an antibiotic regimen, the lesion was unchanged. Dr. Sherman decided to proceed with a Veran procedure to diagnose the lesion.
Planning
Dr. Sherman used the SPiN Planning® software to segment the RUL mass and define a pathway to biopsy the mass using endobronchial navigation. Due to the location of the chest wall lesion outside the lung periphery, Dr. Sherman determined SPiN Perc® would be needed to access the lesion. He planned a trajectory from an anterior approach to percutaneously biopsy the chest wall lesion.
Procedure
A Navigated Bronchoscopy was performed first using SPiN Drive® to access the RUL mass using Always-On Tip Tracked® forceps, brush, and 22ga SPiN Flex® needle. ROSE confirmed malignancy on the 4th pass with the 22ga SPiN Flex® needle. Additional tissue was collected for tumor marking. Dr. Sherman seamlessly transitioned into SPiN Perc® for a navigated TTNA to access the nodule in the chest wall using a 19ga x 105mm percutaneous Always-On Tip Tracked® needle. Core samples were taken as well with the core biopsy gun. Pathology confirmed squamous cell carcinoma metastasis on the chest wall lesion.
