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Tracking of Nodule Movement Key to Diagnosis

Richard J. Leone, MD, PhD, FACS, FCCP

Thoracic Surgeon

Skagit Valley Hospital

Mount Vernon, WA

Patient Information: 69 y/o, M

Scan Protocol: Veran Inspiration/Expiration CT Scan Protocol

Nodule: RLL 14mm

Target Motion: 32mm

Biopsy Result: Adenocarcinoma

Instruments Used: Always-On Tip Tracked® Serrated Forceps

Conclusion: Segmentectomy


“This right lower lobe nodule was only 14mm in size and had significant movement of 32mm with respiration. The SPiN Thoracic Navigation System® allowed us to biopsy the right lung nodule while accommodating for significant respiratory movement. Rapid On-Site Evaluation was able to make a preliminary call from the first-pass with the tip-tracked forceps, which we fortunately have available at Skagit Regional Health.”

Patient History
This was a 69-year-old male that was found to have bilateral lung lesions. The patient underwent a CT-guided biopsy for the left lingular mass, which revealed infiltrating adenocarcinoma. The patient was then referred to Dr. Leone, who opted to utilize the SPiN Thoracic Navigation System® to biopsy the 14mm right lower lobe nodule.

Dr. Leone utilized SPiN Planning® software to segment a 14mm nodule located within the right lower lobe. The SPiN Planning® software revealed that the target was moving 32mm between respiratory phases. Dr. Leone noted the importance of tracking respiration to accurately biopsy the lower lobe target.

Dr. Leone started the procedure with navigation. After registration, Dr. Leone was able to quickly reach the 14mm target utilizing the tip-tracked serrated forceps. He timed each biopsy with matched respiration since the nodule was moving 32mm between respiration. Rapid On-Site Evaluation (ROSE) was in the room and created a touch-prep slide from the first biopsy obtained with the tip-tracked forceps. Upon inspection of the first biopsy, ROSE noted malignant material. Dr. Leone obtained additional samples for cell block. The duration of the procedure was approximately fifteen minutes. The final pathology report revealed that collected samples were morphologically consistent with adenocarcinoma. The patient will undergo a segmentectomy of the right lower lobe.

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