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Unexpected Malignant Diagnosis of RUL Nodule

Dr. Matthew Trump

Pulmonary & Critical Care Medicine

Iowa Methodist Medical Center

Des Moines, IA

Patient Information: 58 y/o, M

Scan Protocol: Veran Inspiration/Expiration CT Scan Protocol

Nodule: RUL 23mm

Target Motion: 14mm

Biopsy Result: Adenocarcinoma

Instruments Used: Always-On Tip Tracked® 21ga Needle, Serrated Forceps & Brush

Conclusion: Surgical Resection


“The SPiN Thoracic Navigation System® allowed me to accurately and confidently sample the nodule in the right upper lobe of the lung. When combined with EBUS, I was able to obtain a cancer diagnosis and complete a staging lymph node survey in one procedure.”

Patient History
This 58-year-old male was referred to Dr. Trump after an incidental finding of a nodule from a CT cardiac calcium score. The nodule was located in the right upper lobe and was PET avid at 4.8 SUV. Additionally, the patient had no significant smoking history, family history of lung cancer, or symptoms.

Dr. Trump utilized the SPiN Planning® software to segment a nodule located within the right upper lobe. Volumetrics of the nodule revealed that it was 23mm in size and was moving 14mm between respiratory phases. Dr. Trump also opted to set a percutaneous entry-point for SPiN Perc® to access the nodule, if needed.

Dr. Trump started the procedure with navigation. After conducting an automatic registration, he was able to successfully navigate to the right upper lobe nodule. Dr. Trump relied on tip-tracked instruments to accurately align trajectory for biopsy. Rapid On-Site Evaluation (ROSE) was present and noted malignant cells upon inspection of the first pass with the tip-tracked 21ga needle. Dr. Trump then obtained additional biopsies utilizing tip-tracked needle, serrated forceps, and brush. After concluding navigation, Dr. Trump proceeded with EBUS in order to complete staging and obtain a diagnosis for the patient within a single procedure. Final pathology findings revealed the right upper lobe nodule was morphologically consistent with adenocarcinoma.

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