Dr. Alberto de Hoyos
Cardiothoracic Surgeon
UT Southwestern – William. P Clements Jr. University Hospital
Dallas, Texas
Patient Information: 71 y/o, F
Scan Protocol: Veran Inspiration/Expiration CT Scan Protocol
Nodule: LLL 20mm Sphere
Target Motion: 13mm
Biopsy Result: Stage cT1b N0M0 Adenocarcinoma
Instruments Used: Always-On Tip Tracked® Serrated Forceps, 19ga Needle & SPiN Perc®
Conclusion: Stereotactic Body Radiation Therapy (SBRT)
“This subsolid nodule would have been difficult to localize using VATS since it would not have been palpable. The patient would have required a localization procedure such as hook wire, coils, fiducials or dye. SPiN Perc® allowed us to achieve the diagnosis expeditiously and less invasively.”
Patient History
This 71-year-old female with a history of smoking and emphysema presented with a 2cm subsolid nodule in the left lower lobe (LLL).
Planning
Using the SPiN Planning® software, Dr. de Hoyos was able to target a subsolid nodule in the LLL using a prone respiratory-gated scan. Due to the density of the target, he opted to drop a 20mm sphere. The target was moving approximately 13mm between respiratory phases. Additionally, Dr. de Hoyos also planned for a prone percutaneous approach.
Procedure
With the patient in a prone position, Dr. de Hoyos began the procedure with an endobronchial approach in order to reach the LLL target. Attempts were made to reach the target utilizing tip-tracked serrated forceps and 19ga needle; however, the physician was unable to reach the target due to lack of a bronchus sign. Dr. de Hoyos opted to transition to SPiN Perc® in order to obtain biopsies. He was able to successfully access the area of interest using the tip-tracked 19ga SPiN Perc® needle and obtained biopsies using the biopsy gun. Final pathology of collected samples were diagnosed as non-small cell carcinoma morphologically consistent with adenocarcinoma. The patient was not a resection candidate due to poor pulmonary function and limited performance status. In this patient, Veran technology allowed us to achieve a final pathologic diagnosis minimally invasively, sparing the patient a surgical biopsy.
