Dr. Daniel Leibman
Pulmonologist
WM Jennings Bryan Dorn Veterans Affairs Medical Center
Columbia, South Carolina
Patient Information: 52 y/o, M
Scan Protocol: Veran Inspiration/Expiration CT Scan Protocol
Nodule: RUL 25mm
Biopsy Results Malignant
Instruments Used: Always-On Tip Tracked® Serrated Forceps, 19ga Needle, 22ga SPiN Flex® Needle, & SPiN Perc®
Conclusion: Squamous Cell Carcinoma; Treatment of local radiation therapy and chemotherapy
“SPiN Perc® enabled us to get a diagnosis of the chest wall lesion during the same procedure as our navigated bronchoscopy. The confirmation of metastasis of squamous cell carcinoma in the chest wall lesion helped expedite the course of treatment for the patient.”
Patient History
The patient is a 52-year-old male with a history of sarcoidosis and a stable fungal mass in the left upper lobe. A recent CT scan revealed a mass in the right upper lobe as well as a nodule along the pectoralis muscle in the chest wall outside the lung. Both nodules were positive upon a PET scan. Dr. Leibman scheduled the patient for a procedure with Veran to diagnose the RUL mass and determine if the chest wall lesion is a metastasis, second primary cancer, or infection.
Planning
Dr. Leibman used the SPiN Planning® software to segment the RUL mass and define a pathway to biopsy the mass using endobronchial navigation. Due to the location of the chest wall lesion outside the lung periphery, Dr. Leibman determined SPiN Perc® would be needed to access the lesion. He planned a trajectory from an anterior approach to percutaneously biopsy the chest wall lesion.
Procedure
A Navigated Bronchoscopy was performed first using SPiN Drive to access the RUL mass using Always-On Tip Tracked® forceps, brush, and 22ga SPiN Flex® needle. ROSE confirmed malignancy on the 4th pass with the 22ga SPiN Flex® needle. Additional tissue was collected for tumor marking. Dr. Leibman seamlessly transitioned into SPiN Perc for a navigated TTNA to access the nodule in the chest wall using a 19ga x 105mm percutaneous Always-On Tip Tracked® needle. Core samples were taken as well with the core biopsy gun. Pathology confirmed squamous cell carcinoma metastasis on the chest wall lesion.
