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Localization and Diagnosis of 9mm GGO Nodule

RESECTION OF RECURRENT CANCER
Author
Dr. Sebastian Wiesemann

Assistant Professor, Division of Thoracic and Cardiovascular Surgery

University of Missouri Healthcare

Columbia, MO

Patient Information: 67 y/o, F

Scan Protocol: Veran Inspiration/Expiration CT Scan Protocol

Nodule: RML 9mm GGO

Biopsy Result: Malignant

Instruments Used: Always-On Tip Tracked® Serrated Forceps & SPiN Perc™ 1cm Localization Kit

Conclusion: Adenocarcinoma in-situ. Routine Follow-up.

Observations

“We resected the wedge solely on focusing on the dye marking and hook-wire marking from the Veran localization; the GGO nodule was not palpable or visible. Pathology confirmed a 9mm adenocarcinoma with clear margins.”

Patient History
This patient is a former smoker with a history of multifocal adenocarcinoma. Two small, well differentiated adenocarcinomas were removed via a RUL wedge resection at the University of Missouri hospital one year ago. During a routine follow-up CT scan, an enlarging GGO nodule was observed in the RML.

Planning
Due to the GGO nature and size of the lesion, Dr. Wiesemann would not be able to palpate or accurately see the nodule and decided he would need Veran to localize prior to resection. The patient was scanned in the lateral decubitus position with Veran protocol. Upon review of the CT scan, Dr. Wiesemann dropped a 10mm sphere to target the RML nodule. The distance from skin to center of the target was measured to be 56mm. He planned to use the same entry point to first insert a hook wire through the SPiN Perc™ introducer needle, and then inject dye to mark the nodule using the SPiN Perc™ 1 cm localization needle.

Procedure
The patient was intubated and positioned in left decubitus thoracotomy position. After a quick registration with forceps, the procedure transitioned to SPiN Perc™. Dr. Wiesemann first lined up the 105mm SPiN Perc™ needle to the center of the target, removed the stylet, and inserted a hook wire to mark the location of the nodule. To add another method of localization, Dr. Wiesemann then used the SPiN Perc™ 1 cm localization needle to inject 0.6cc of dye into the center of the target. As soon as the VATS procedure began, Dr. Wiesemann was quickly able to identify to location of the nodule by the hook wire and the dye marking. He resected a wedge around the marking for an immediate evaluation by pathology. Pathology confirmed the presence of the GGO nodule and a diagnosis of adenocarcinoma in situ. Due to the accurate localization and clean margins, Dr. Wiesemann was able to conclude the procedure without removing additional healthy lung tissue.

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