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Difficult Nodule Staged and Diagnosed in One Procedure

Dr. Devin Sherman

Pulmonary Disease

Williamson Medical Center

Franklin, Tennessee

Patient Information: 47 y/o, F

Scan Protocol: Veran Inspiration/Expiration CT Scan Protocol

Nodule: RML 15mm

Target Motion: 19mm

Biopsy Result: Non-Small Cell Carcinoma

Instruments Used: Always-On Tip Tracked® Forceps & SPiN Perc®

Conclusion: Resection


“The opportunity to perform percutaneous biopsies is a game changer: giving the Pulmonologist the ability to both stage and diagnose a patient in a single procedure using both endobronchial and percutaneous approaches.”

Patient History
This 47 year-old female with an extensive history of smoking presented with a 15mm nodule in the RML.

Using a same day respiratory-gated scan and the SPiN Planning® software, Dr. Sherman targeted a 15mm RML nodule that showed 19mm of movement during the respiratory cycle.

Dr. Sherman started the procedure with Linear EBUS and then transitioned to navigation. Multiple attempts were made to access the nodule endobronchially, but due to the difficult location in the superior segment of the RML, the nodule was not accessible. Dr. Sherman then elected to proceed with SPiN Perc® to obtain biopsies. After seamlessly transitioning to SPiN Perc® Dr. Sherman successfully navigated the Always-On Tip Tracked® 19ga percutaneous needle to the nodule. While advancing the needle, he closely monitored the respiratory cycle for accurate placement of the needle in the nodule that was moving a distance equal to its size. Multiple core biopsies were taken and ROSE was able to make a diagnosis of non-small cell carcinoma.

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