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Respiratory Gating Crucial to Biopsy Subcentimeter Nodule

Dr. Franklin Quijano

Interventional Pulmonologist

University of Kansas Medical Center

Kansas City, KS

Patient Information: 63 y/o, F

Scan Protocol: Veran Inspiration/Expiration CT Scan Protocol

Nodule: RML 8mm

Target Motion: 4mm

Biopsy Result: Carcinoid Neuroendocrine Tumor

Instruments Used: Always-On Tip Tracked® Serrated Forceps & SPiN Flex®

Conclusion: Surgical Resection


“This nodule would have been inaccessible without Veran. Due to the location being near the hilar region with surrounding blood vessels, it would have been impossible for IR to reach using CT-guided. With Veran navigation, I was able to reach the 8mm nodule located near the heart and diaphragm.”

Patient History
This 63-year-old female was referred to Dr. Quijano due to a persistent cough and concern for ILD. The patient was a non-smoker and had no former history of cancer. The 8mm right middle lobe nodule was found incidentally.

Dr. Quijano utilized SPiN Planning® software to segment a nodule located within the right middle lobe. Volumetrics from the planning software revealed that this medial subcentimeter nodule was 8mm in size and moving 4mm during respiration. Once the planning portion of the procedure was complete, the plan was sent to the SPiN Drive® system utilizing SPiN Link® technology.

Dr. Quijano opted to start the procedure with navigation. He was able to successfully navigate to the medial subcentimeter nodule located within the right middle lobe utilizing the SPiN Flex® needle and tip-tracked forceps. Respiratory gating played a crucial role in order to successfully biopsy the moving target. Inspection of the collected samples with the SPiN Flex® needle revealed malignant cells. The final pathologic report revealed that the collected samples of the tumor were morphically consistent with Carcinoid Neuroendocrine. The patient was referred to cardiothoracic surgery for resection.

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