Dr. Michael Barretti
Pulmonologist
St. Luke’s Hospital
New Bedford, MA
Patient Information: 50 y/o, F
Scan Protocol: Veran Inspiration/Expiration CT Scan Protocol
Nodule: 40mm LUL
Target Motion: 14mm
Biopsy Result: Strep Salivarius
Instruments Used: SPiN Perc® Biopsy Kit, SPiN Flex® 22ga Needle, Always-On Tip Tracked® Forceps and Brush
Conclusion: Repeat Lung CT in Three Months
When endobronchial biopsies were not providing strong enough samples for pathology, Dr. Barretti made the decision to perform his first percutaneous biopsy using SPiN Perc® to gather the needed tissue. “I was surprised at the ease and accuracy of this technique. Overall, I was extremely confident in the quality of the samples, and I was impressed with the user-friendliness of the system.” Tissue samples obtained percutaneously helped confirm the mass in the patient’s left upper lobe was consistent with the previous unresolved fungal infection.
Patient History
This 50-year-old female was being treated with antibiotics by Dr. Barretti for a severe left upper lobe community-acquired pneumonia diagnosed earlier in the year. The woman was never a smoker but had a history of mild asthma and mold exposure in her workplace. Serial CT imaging scans were showing overall improvement, but symptoms of pleuritic pain, night sweats, and a non-resolving solid component in the region of the previous infectious consolidation persisted. Dr. Barretti made the decision to biopsy the solid region. He scheduled a navigated bronchoscopy.
Planning
The patient underwent a same-day respiratory gated CT scan for Dr. Barretti to use with Veran’s SPiN Planning® software. He selected the 40mm solid portion of the mass in the left upper lobe and found 14mm of movement between respiratory states. The target appeared to be accessible for endobronchial sampling, but Dr. Barretti planned for a percutaneous approach as well.
Procedure
Dr. Barretti began the navigated bronchoscopy using the SPiN Drive® software to automatically register the patient’s airways. He successfully reached the target and waited for the monitored respiratory state to show the patient was in expiration before taking endobronchial samples with the Always-On Tip Tracked® Forceps, Brush, and SPiN Flex® 22ga Needle. Rapid On-Site Examination (ROSE) analyzed the tissue seeing suspicious material but asked for more tissue. Dr. Barretti decided to transition to SPiN Perc® to obtain larger core samples with the biopsy gun. After quickly setting up for the semi-sterile procedure, he lined up the trajectory of his SPiN Perc® Introducer Needle and advanced the needle to the target on matched respiration. Dr. Barretti proceeded to take several samples of the mass from which final pathology reported the tissue positive for Strep Salivarius. Dr. Barretti will continue treating the infection and monitor the patient’s condition with a repeat CT Scan in three months.
