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Patient Elects To Have Non-Invasive Procedure

ADENOCARCINOMA CONTAINING LEPIDIC GROWTH
Author
Dr. Mohammed Alnijoumi

Pulmonary, Critical Care, Environmental Medicine

University of Missouri Health Care

Columbia, Missouri

Patient Information: 61 y/o, F

Scan Protocol: Veran Inspiration/Expiration CT Scan Protocol

Nodule: RUL 23mm

Target Motion: 3mm

Biopsy Results: Adenocarcinoma containing lepidic growth

Conclusion: Surgical Resection

Observations

“The patient was opposed to an invasive procedure after the complication in IR causing the pneumothorax. There was no direct bronchus sign that appeared on the CAT scan. However, there were airways that lead me close to the nodule. I trusted that the system would get me to the nodule despite the lack of bronchus sign—and it did.”

Patient History
This 61-year-old female with a history of one pack per day smoking and COPD presented with a 23mm nodule in the RUL that was PET positive. She had previously undergone a nondiagnostic CT guided biopsy that resulted in pneumothorax. The patient did not want to undergo another invasive procedure and instead found that Veran’s ENB would be a safer and less invasive option.

Planning
Using the SPiN Planning™ software, Dr. Alnijoumi segmented a 23mm target in the right upper lobe and selected an additional target located near the nodule on a small airway that had to be manually grown.

Procedure
Dr. Alnijoumi began the procedure using Linear EBUS obtaining samples from 11L and 11R that were ultimately negative. After completing all of the necessary sampling with EBUS, he transitioned to electromagnetic navigation. He was able to quickly navigate to the 23mm RUL target and obtain multiple samples using an Always-On Tip Tracked® SPiN Flex™ needle, Serrated Cup Forceps and Brush to obtain multiple samples. ROSE was not present for the procedure; however final pathology reported the samples to be positive for Adenocarcinoma containing lepidic growth. The patient recovered well from the procedure and was sent for a surgical consult.

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