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SPiN Perc™ Key to Accessing Nodule in Difficult Location

NAVIGATED TTNA OF LUL NODULE
Author
Dr. Mark Boomer

Pulmonologist

St. John Broken Arrow Hospital

Broken Arrow, OK

Patient Information: 63 y/o, M

Scan Protocol: Veran Inspiration/Expiration CT Scan Protocol

Nodule: LUL 33mm

Biopsy Result: Malignant

Instruments Used: SPiN Perc™, Always-On Tip Tracked® Serrated Forceps and 19 ga Needle

Conclusion: Squamous Cell Carcinoma; Treatment of local radiation therapy and chemotherapy

Observations

“SPiN Perc™ is a major advantage of the Veran system. Using SPiN Perc™ in combination with navigated bronchoscopy was crucial in obtaining enough tissue for pathology to confirm a diagnosis of this nodule.”

Patient History
The patient is a 63-year-old male with a history of previous lung cancer in 2018. A nodule in the LUL, previously marked with a fiducial for radiation, had grown in size over the last few months. The patient was referred to Dr. Boomer for a navigated bronchoscopy and possible navigated TTNA to determine if the nodule is a recurrence or a new type of malignancy.

Planning
Dr. Boomer used the SPiN Planning™ software to segment the LUL mass and define a pathway to biopsy the mass using endobronchial navigation. He then planned a trajectory to access the nodule using SPiN Perc™. Although the nodule was in a difficult location, close to the patient’s aorta, Dr. Boomer was able to carefully plan a path with the SPiN Planning™ software.

Procedure
A Navigated Bronchoscopy was performed first using SPiN Drive® to access the LUL mass using Always-On Tip Tracked® forceps and 19ga needle. To be certain he obtained enough tissue to fully diagnose the lesion, Dr. Boomer transitioned to a SPiN Perc™ procedure. The nodule was located very close to the aorta. Respiratory gating as well as using all 3 entry views on the system was key in making access smooth to this difficult location. Dr. Boomer used a 19ga x 105mm percutaneous Always-On Tip Tracked® introducer needle, FNA needle, and core biopsy gun to take multiple samples of the lesion. Pathology determined the nodule was malignant, and specifically a recurrence of squamous cell carcinoma.

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