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Difficult Right Upper Lobe Nodule Diagnosed

Dr. Kalpesh Patel

Internal Medicine / Pulmonary Disease

Seton Hays Medical Center

Kyle, Texas

Patient Information: 70 y/o, F

Scan Protocol: Veran Inspiration/Expiration CT Scan Protocol

Nodule: RUL 28mm

Target Motion: 1mm

Biopsy Result: Squamous Cell Lung Cancer

Instruments Used: Always-On Tip Tracked® Serrated Forceps, 19ga Needle & SPiN EWC®

Conclusion: Possible enrollment in immunotherapy trial


“This was a very difficult case due to fibrotic airways and parenchyma located in the area of interest. The mixture of the inflammation, malignancy and possible infection also created a challenge. The SPiN System® helped to obtain reliable tissue samples.”

Patient History
This 70 year-old female patient with a history of COPD, breast cancer and squamous lung cancer was referred to Dr. Patel. An initial lobectomy of the left lung was conducted in 2003. The right upper lobe (RUL) nodule was noted in ’13. Patient underwent SBRT and had a stable CT chest until ’15. A subcentimeter juxta esophageal nodule was discovered and the patient underwent XRT. Recurrence was discovered in ’17 and patient underwent proton therapy. Ultimately, CT scans revealed that the RUL nodule was increasing in size.

Dr. Patel utilized SPiN Planning® software to create a 3D segmentation of a 28mm nodule located in the apical segment of the RUL. SPiN Planning® software revealed that the nodule was moving approximately 1mm between respiratory phases.

After performing Linear EBUS and obtaining adequate samples, Dr. Patel transitioned to navigation and was able to successfully navigate to the nodule located in the apical segment of the RUL using the SPiN EWC®. He was able to obtain samples using Always-On Tip Tracked® Serrated Forceps, 19ga Needle, and Brush. Rapid on-site evaluation (ROSE) was used for the procedure and identified ‘very atypical’ cells while in the room. Final pathology reported that the EBUS mediastinal staging was negative with lymph nodes adequately biopsied, while the endobronchial navigated brush samples yielded a diagnosis of Squamous Cell Lung Cancer.

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