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Diagnosis and Fiducial Placement in One Procedure with SPiN Perc™

NAVIGATED TTNA AND FIDUCIAL MARKING OF RUL MASS
Author
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

Observations

“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.

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