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Malignancy Detected and Removed Prior to Metastasis with the Help of Always-On Tip Tracked® Instruments

ADENOCARCINOMA DETECTED IN THE RIGHT UPPER LOBE
Author
Dr. Anthony Ortegon

Pulmonologist

Texas Health Presbyterian

Dallas, TX

Patient Information: 72 y/o, M

Scan Protocol: Veran Inspiration/Expiration CT Scan Protocol

Nodule: 33mm RUL

Target Motion: 12.4mm

Biopsy Result: Non-Small Cell Lung Cancer; Adenocarcinoma

Instruments Used: Always-On Tip Tracked® 21ga Needle, 19ga Needle, and Brush

Conclusion: Robotic Right Upper Lobectomy

Observations

Dr. Ortegon stated, “The diagnosis was quickly made given my ability to confidently biopsy a difficult-to-reach lung mass given the anomalous RUL take-off and location within the lobe. The tip tracked technology allowed me to biopsy the mass nine times with enough samples to achieve a presumptive diagnosis on ROSE while not suffering any complications. Given my ability to quickly and accurately diagnose the patient’s malignancy, he was able to undergo an uncomplicated robotic lobectomy with clean margins. Veran’s technology unequivocally allowed this patient to undergo curative resection prior to the development of metastatic physiology.”

Patient History
This 72-year-old male was referred to Dr. Ortegon following the detection of a 27mm spiculated nodule in a chest CT ordered by the patient’s primary care provider to address the patient’s progressive dyspnea. A PET CT displayed signs of isolated, hypermetabolic disease of the right upper lobe mass. Despite the patient’s medical history of Parkinson’s disease, Chronic Obstructive Pulmonary Disease (COPD), and emphysema, the patient still displayed a good pulmonary functional status. A navigated bronchoscopy utilizing the SPiN Thoracic Navigation System® was scheduled.

Planning
Dr. Ortegon used the SPiN Planning® software with a same-day respiratory gated CT scan to prepare for his procedure. The right upper lobe target was segmented on the same-day CT scan and was seen to have grown from 27mm to a 33mm mass. The software showed the mass to be 35.7mm from a known airway. The overlay of inspiratory and expiratory CT scans showed the nodule to be moving a distance of 12.4mm throughout respiration.

Procedure
Dr. Ortegon inspected the patient’s airways prior to beginning the navigated bronchoscopy. He then used a therapeutic bronchoscope with a tip-tracked instrument to perform an automatic registration in Veran’s SPiN Drive® software. He continued his procedure navigating to his target and manipulated his scope beyond an anomalous right upper lobe take-off and into the posterior segment. Dr. Ortegon performed six transbronchial needle aspirations with the Always-On Tip Tracked® 21ga Needle followed by three more with the tip-tracked 19ga Needle. He then used the tip-tracked brush to collect a brushing sample and finished his procedure with a bronchoalveolar lavage (BAL). Dr. Ortegon and his staff completed this procedure, including the navigation portion, without vendor presence due to the system’s ease of use. No evidence of hemorrhage was observed. Rapid On-Site Evaluation (ROSE) assumed an initial diagnosis of non-small cell lung cancer later confirmed to be Adenocarcinoma with no signs of metastasis. The patient underwent a right upper lobectomy with clean margins and no complications observed two months after the initial finding of the mass.

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