Dr. Tufik Assad
Pulmonologist
Williamson Medical Center
Franklin, TN
Patient Information: 63 y/o, M
Scan Protocol: Veran Inspiration/Expiration CT Scan Protocol
Nodule: RLL 41mm
Target Motion: 22mm
Biopsy Result: Squamous Cell Carcinoma
Instruments Used: Always-On Tip Tracked® 22ga SPiN Flex®, SPiN Xtend®, Serrated Forceps, & Brush
Conclusion: Proton Radiation Therapy
“This case was a great example of the versatile products Veran offers. Although I was able to navigate to the nodule endobronchially using the SPiN Flex® needle and serrated forceps, the biopsy specimens were still nondiagnostic, likely because the mass was located very posterior and medial in the patient’s superior segment of his RLL. Having the option to use the SPiN Xtend® needle in this case from a more proximal airway ensured the patient got the diagnosis in one procedure.”
Patient History
This 63-year-old male patient was referred to Dr. Assad after undergoing a low dose CT scan for lung cancer screening. The CT scan revealed a lung mass within the right lower lobe. He presented with a history of heavy tobacco abuse (>100 pack years), emphysema, interstitial lung disease, and an extensive family history of lung cancer.
Planning
A same-day Inspiration/Expiration CT scan was performed using Veran’s CT protocol. Dr. Assad utilized the SPiN Planning® software to segment a mass located within the superior segment of the right lower lobe. The SPiN Planning® software revealed that the mass was 41mm in size and moving 22mm during respiration.
Procedure
Dr. Assad started the procedure with linear EBUS in order to stage the mediastinum. Dr. Assad then proceeded with navigation. After conducting an automatic registration, he was able to successfully navigate to the right lower lobe mass with tip-tracked serrated forceps and SPiN Flex® needle. To obtain more tissue for diagnosis, Dr. Assad then opted to utilize the SPiN Xtend® needle. After properly aligning the trajectory, he opted to set the throw to 3cm. After he collected adequate samples with the SPiN Xtend® needle, Dr. Assad then placed fiducials using the tip-tracked brush. The final pathology report revealed that biopsies obtained with the SPiN Xtend® needle were morphologically consistent with squamous cell carcinoma. The patient was then referred to a medical and radiation oncologist and opted to undergo proton radiation therapy.
