Real-Time, Image-Guided Cryobiopsy and Diagnosis
of a 10mm Right Upper Lobe (RUL) Lesion
Case Details
Lesion Characteristics
Lesion Size (diameter): 10 mm
Lesion Location: Right Upper Lobe (RUL)
Bronchus Sign: Yes
Visible on Fluoro: No
Case Information
Final Pathology Report: Pulmonary adenocarcinoma
Background
A 71-year-old female with a history of smoking and COPD presented with a solitary pulmonary nodule in the right lung measuring 1.0 x 1.0 x 0.8 cm. The lesion had doubled in size over six months. A navigational bronchoscopy using the LungVision® (Body Vision Medical) platform was selected for biopsy.
The Procedure
The lesion was difficult to visualize with standard fluoroscopy but was clearly identified
using C-arm-based tomography with LungVision. The cryoprobe was employed to
obtain tissue, with “tool-in-lesion” confirmation with LungVision ensuring accurate
sampling. Histopathology confirmed pulmonary adenocarcinoma. The patient
underwent surgical resection, achieving curative intent without the need for adjuvant
therapy.
Conclusion
The benefits of lung cancer screening programs have been well documented with the Nelson Study and the national lung cancer screening trial.1,2 The reason behind this improvement is the shift of the initial TNM Stage in which the cancer is diagnosed.³ Diagnosing pulmonary nodules at an earlier stage represents a challenge for pulmonologists because the lung lesions are smaller and more difficult to target to confirm or exclude malignancy. Early diagnosis of small lung nodules, as facilitated by the LungVision platform, is critical for improving patient outcomes. This case illustrates how augmented fluoroscopy and real time imaging can overcome the challenges posed by small lesion size and enhance diagnostic precision during an endobronchial lung nodule biopsy procedure.
References
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National Lung Screening Trial Research Team; Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, Fagerstrom RM, Gareen IF, Gatsonis C, Marcus PM, Sicks JD. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011 Aug 4;365(5):395-409. doi: 10.1056/NEJMoa1102873. Epub 2011 Jun 29. PMID: 21714641; PMCID: PMC4356534.
Vachani A, Carroll NM, Simoff MJ, Neslund-Dudas C, Honda S, Greenlee RT, Rendle KA, Burnett-Hartman A, Ritzwoller DP. Stage Migration and Lung Cancer Incidence After Initiation of Low-Dose Computed Tomography Screening. J Thorac Oncol. 2022 Dec;17(12):1355-1364. doi: 10.1016/j.jtho.2022.08.011. Epub 2022 Sep 7. PMID: 36087860; PMCID: PMC9703625
About Dr. Björn Schwick Dr. med. José Miguel Sodi Luna
Dr. Björn Schwick
Chief Physician
Department of Pulmonology
Luisenhospital Aachen
Aachen, Germany
Dr. med. José Miguel Sodi Luna
Senior Physician
Department of Pulmonology
Luisenhospital Aachen
Aachen, Germany