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Precise Localization of Nodule Aids in Sparing Healthy Lung Tissue

LOCALIZATION OF 7MM GGO NODULE
Author
Dr. Karl Uy

Chief of Thoracic Surgery

UMass Memorial Medical Center

Worcester, MA

Patient Information: 62 y/o, M

Scan Protocol: Veran Inspiration/Expiration CT Scan Protocol

Nodule: LUL 7mm

Biopsy Result: Malignant

Instruments Used: Always-On Tip Tracked® Guidewire, and 1cm Localization SPiN Perc™ Kit

Conclusion: Successful resection of adenocarcinoma

Observations

“We could have performed a large wedge resection to encompass the nodule, but we preferred to use Veran as a localization modality for the most precise resection. Also, this method of localization is done by the surgeon after the induction of general anesthesia, which is more convenient (than an IR procedure) and less painful for the patient.”

Patient History
A 62-year-old male, former smoker, presented with a 5-mm cavitary lung nodule in the left upper lobe during a routine lung cancer screening chest CT scan. After three months of observation, the nodule grew in size to 7mm. Due to the ability to locate the nodule based on it’s size, location, and subsolid nature. He decided to utilize Veran for percutaneous localization.

Planning
Upon review of the CT scan, Dr. Uy noted the extremely small size and cavitation of the nodule. He decided to use the 1cm SPiN Perc™ Localization Needle to dye-mark the nodule and planned his trajectory and entry point accordingly. He planned to place a dye marking slightly deeper than the lesion to avoid injection directly into the cavitation.

Procedure
The patient was intubated and positioned in left lateral decubitus position for thoracotomy. After a quick registration with the Always-On® Tip Tracked Guidewire, the procedure transitioned to SPiN Perc™. Dr. Uy used the SPiN Perc™ 1cm Localization Needle to inject 0.6cc of dye slightly deeper than the 7mm cavitated nodule. As the robot-assisted thoracoscopic surgery began, Dr. Uy was quickly able to identify the dye marking using near-infrared fluorescence imaging. He performed a wedge resection encompassing the marking and reimaged the staple line to ensure no dye marking was left on the margin. Frozen section of the specimen revealed a lepidic adenocarcinoma with clean margins. Since there was no obvious sign of invasion on pathology, no further removal of health lung tissue was done.

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