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From Watchful Waiting to Stage IA Diagnosis

Dr. James A. Apostle

Pulmonary Medicine

St. Mary’s Bon Secours

Richmond, Virginia

Patient Information: 49 y/o, F

Scan Protocol: Veran’s Inspiration/Expiration CT Scan Protocol

Nodule: LUL 15mm

Target Motion: 9mm

Biopsy Results: Squamous Cell Carcinoma

Instruments Used: Always-On Tip Tracked® Forceps

Conclusion: Stage IA Squamous Cell Carcinoma Treated with SBRT


“Navigation was key in obtaining a diagnosis endobronchially due to the fact the patient was deemed not to be a surgical candidate by the multidisciplinary tumor board.”

Patient History
A 49 year-old female every day smoker, presented with a Left Upper Lobe (LUL) solitary pulmonary nodule (SPN) with an uptake of 5.2 SUV on PET. The SPN measured 15mm and just three months prior measured 8mm, almost doubling in size.

Using Veran’s same-day Inspiration/Expiration CT scan protocol, a vPad® was placed and the scan was sent to the planning station via DICOM. The LUL nodule was noted having 9mm of motion during the respiratory cycle. The SPiN Planning® software was used to automatically segment the 15mm LUL nodule.

Using Veran’s SPiN Thoracic Navigation System® and a pre-determined pathway, Dr. Apostle was able to obtain multiple biopsies of the set target in the LUL. Due to nearly 1cm of motion during the respiratory cycle, the biopsies were accurately obtained using respiratory gating to let Dr. Apostle know when the position of the nodule matched the CT data being used. After obtaining enough biopsies for pathology to be able to make a definitive diagnosis, a BAL of the LUL was performed prior to ending the procedure. The patient recovered from the procedure without event and was discharged home the same day. Final pathology results indicated Stage IA Squamous Cell Carcinoma, and the patient was treated with SBRT.

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