Dr. Chakradhar Kotaru
Pulmonologist
Critical Care and Pulmonary Consultants
The Medical Center of Aurora
Aurora, CO
Patient Information: 81 y/o, F
Scan Protocol: Veran Inspiration/Expiration CT Scan Protocol
Nodule: LLL 19mm
Target Motion: 24mm
Biopsy Result: Squamous Cell
Instruments Used: Always-On Tip Tracked® 22ga SPiN Flex®, Serrated Forceps, Brush, & SPiN Access Catheter®
Conclusion: Stereotactic Body Radiotherapy
“We performed navigational bronchoscopy with the SPiN Thoracic Navigation System® at The Medical Center of Aurora. The same-day CT scan showed an increase in size of the left lower lobe nodule. Given the small nature of the airways and location of the nodule, the lesion was not accessible with a standard bronchoscope. The SPiN Access Catheter® was used to reach and assist with biopsy of this challenging nodule.”
Patient History
This 81-year-old female was recently seen in the emergency department for abdominal pain. A CT scan revealed an incidental finding of a 16mm spiculated nodule within the left lower lobe. The patient was a current heavy smoker since the age of 12 (1 – 1.5 packs per day with over 100 pack year history). The patient also presented with moderate severity emphysema and no metastatic disease. The patient’s care was discussed at the multi-disciplinary lung cancer conference and it was decided that the patient would undergo navigational bronchoscopy with Dr. Kotaru.
Planning
A same-day Inspiration/Expiration CT scan was performed using Veran’s CT protocol. Dr. Kotaru utilized the SPiN Planning® software to identify a 19mm left lower lobe nodule located within the superior segment. A sphere was placed on the target and the SPiN Planning® software revealed that the nodule was moving 24mm during respiration.
Procedure
Dr. Kotaru started the procedure with linear EBUS to stage the mediastinum. After obtaining adequate samples, he proceeded with navigation. He started the procedure with a slim scope in conjunction with tip-tracked instruments to reach the target. However, given the challenging location of the LLL target, he opted to use the SPiN Access Catheter®. Dr. Kotaru was able to successfully reach the area of interest with the SPiN Access Catheter®. Once in place, he obtained biopsies utilizing the tip-tracked serrated forceps, SPiN Flex® needle, and brush. The final pathology report revealed that collected samples from the navigated bronchoscopy were morphologically consistent with squamous cell lung cancer. The patient was referred to medical radiation and oncology for treatment. The time from nodule discovery to diagnosis was 48 days.
