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SPiN Access Catheter® Essential in Reaching Difficult Nodule

BIOPSY OF 9MM NODULE WITH 32MM OF RESPIRATORY MOTION
Author
Dr. Sapna Bhatia

Pulmonologist

MountainView Hospital

Las Vegas, NV

Patient Information: 57 y/o, M

Scan Protocol: Veran Inspiration/Expiration CT Scan Protocol

Nodule: 9mm RML

Target Motion: 32mm

Biopsy Result: Malignant

Instruments Used: SPiN Access Catheter®, 90 degree, SPiN Flex® 22ga Needle, Always-On Tip Tracked® Forceps

Conclusion: Neuroendocrine tumor; Chemotherapy

Observations

“I utilized the Veran technology to successfully navigate to the 9mm target in the RML. The nodule movement was 32mm from inspiration to expiration, so having a system that could track respiratory movement was crucial in obtaining a diagnosis for this patient.”

Patient History
This 57 year-old male patient did not have any history of smoking. He was previously diagnosed with follicular thyroid cancer in 2013 in which he underwent a surgical resection in 2014 for treatment. A routine chest CT scan discovered several lung nodules measuring 4-6mm in diameter. None of the nodules were large enough to be characterized by PET CT, so a follow-up CT scan was scheduled. The following CT-scan showed growth of one nodule to 9mm. Dr. Bhatia decided to proceed with a Veran navigational bronchoscopy to diagnose the nodule.

Planning
The patient was scanned in the supine position with Veran CT scan protocol. Dr. Bhatia reviewed the scan and made a plan for navigation and biopsy using the Veran SPiN Planning® software. She immediately noted the calculated 32mm respiratory motion of this nodule during the inspiration and expiration breath cycle. Although Dr. Bhatia had originally planned to use a slim diagnostic scope to reach the lesion, the great amount of respiratory motion led her to think the SPiN Access Catheter® would be needed to lock position to access the nodule.

Procedure
After a quick registration, Dr. Bhatia first attempted to navigate to the target using a slim diagnostic scope. She was not able to make one of the last turns into the final airway connected to the nodule and did not have the stability to hold position due to the respiratory motion. She switched to a scope with a slightly larger working channel in order to use the SPiN Access Catheter®, 90 degree to reach the target. The angle of the catheter and the ability of the catheter to lock in position enabled Dr. Bhatia to reach and biopsy the nodule. She took several samples of the nodule using the SPiN Flex® 22ga Needle and the Always-On Tip Tracked® forceps. ROSE was able to confirm sufficient tissue for a diagnosis. Final pathology concluded a neuroendocrine tumor. The respiratory gating technology of the SPiN Drive® software and the SPiN Access Catheter® helped Dr. Bhatia biopsy this nodule, resulting in a definitive diagnosis.

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