Giuseppe Casablanca, MD
Thoracic Surgeon
Azienda Ospedaliera Papardo
Chirurgia Toracica
Messina, Italy
Patient Information: 72 y/o, F
Scan Protocol: Veran Inspiration/Expiration CT Scan
Nodule: 16mm
Target Motion: 17mm
Biopsy Result: Adenocarcinoma
Instruments Used: Always-On Tip Tracked® Brush, Serrated Forceps, and 19ga Needle
Conclusion: Surgical Resection
”In spite of the evidence that the nodule had remained unchanged, we decided to biopsy the lesion with the SPiN System®. The Always-On Tip Tracked® tools help provide the confidence to biopsy the lesion to get an answer for the patient. This experience demonstrates the high value of the SPiN System® in the diagnosis of early peripheral lung cancer.”
Patient History
This patient is a 72-year-old female who presented with a 20 pack-year smoking history. Approximately two years ago, a 16mm subsolid opacity of the right upper lobe (RUL) was detected through a CT scan of the chest. The PCP advised a protocol of radiological follow up. Two years later, the pulmonologist referred the patient to Dr. Casablanca, who gave indication to biopsy with the SPiN System® despite the lesion having been unchanged over the course of the last two years.
Planning
A CT scan using Veran’s same-day inspiration / expiration protocol was conducted prior to the procedure. Dr. Casablanca utilized the SPiN Planning® software to segment a target located in the RUL. The SPiN Planning® software revealed that the nodule was 16mm in size and moved 17mm during the respiratory cycle. Dr. Casablanca planned to sample the lesion with tip-tracked serrated forceps and needle.
Procedure
The patient was placed under general anesthesia and Dr. Casablanca started the procedure with navigation. After conducting an automatic registration, Dr. Casablanca utilized the tip-tracked brush and successfully reached the RUL nodule. After conducting a brushing of the lesion, he utilized the tip-tracked serrated forceps and collected several biopsies. He then opted to use the tip-tracked 19ga needle to obtain histological samples. Dr. Casablanca maintained navigational guidance during biopsy of the RUL nodule because of the Always-On Tip Tracked® biopsy tools, without the need for fluoroscopy. Samples obtained from navigation revealed that the nodule was adenocarcinoma. The patient accepted the operation of a RUL lobectomy and lymphadenectomy. The pathologist demonstrated that the cancer was 7mm in size and surrounded by an area of atypical adenomatous hyperplasia. Results from the mediastinal lymph node dissection were negative. The final diagnosis was adenocarcinoma of the lung pT1a N0 M0, stage IA1.
