Dr. Eric Flenaugh
Chief & Director of Pulmonary and Critical Care & Interventional Pulmonary Medicine
Grady Memorial Hospital
Atlanta, Georgia
Patient Information: 86 y/o, F
Scan Protocol: Veran Inspiration/Expiration CT Scan Protocol
Nodule: 14 X 4mm
Target Motion: 33mm
Instruments Used: Always-On Tip Tracked® Forceps & Brush
Biopsy Results: Lepidic Adenocarcinoma
Conclusion: SBRT
“This was a slow growing ground glass nodule that had been followed over a 2 year period. Given the risk factors for cancer and the patient’s excellent performance status, the decision to pursue a diagnosis was made. Navigation was critical to being able to diagnose this small GGO, as it would not have been visible with fluoroscopy.”
Patient History
The patient is an 86 year-old chronic (30-year) tobacco user that was noted to have an incidental right lower lobe (RLL) ground glass pulmonary nodule measuring 11 x 4mm on a prior CT scan. On follow-up serial CT imaging, the ground glass nodule had increased in size to 14 x 4mm. Diagnostic and treatment options were discussed with the patient. She declined surgical diagnosis and treatment but did agree to navigational bronchoscopy for diagnosis and fiducial placement, to be followed with SBRT if it was determined to be cancer.
Planning
Veran’s SPiN Planning® software, in addition to a same-day respiratory gated scan was used to target the 14mm ground glass pulmonary nodule for biopsy and fiducial placement. Respiratory gating was key due to the 33mm of movement between inspiration and expiration.
Procedure
With the patient under conscious sedation, Dr. Flenaugh performed an initial inspection of the airways prior to proceeding with ENB. He then used an Always-On Tip Tracked® serrated cup forceps to successfully access and obtain eight biopsies. Once enough biopsies were obtained for ROSE diagnosis by Pathologist, Dr. Flenaugh successfully placed two 0.75 x 5mm Visicoil fiducial markers around the targeted area using an Always-On Tip Tracked® brush. Final diagnosis was Lepidic Adenocarcinoma and the patient was sent for SBRT.
