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SPiNPerc Expands Lung Lesion Diagnosis Options

Andrea K. Anthony, MD

Andrea K. Anthony, MD

Dr. Anthony earned her medical degree from the University of Kansas School of Medicine, where she also completed her residency and fellowship in pulmonary/critical care.

SPiNPerc is a minimally invasive percutaneous needle biopsy procedure that allows physicians to biopsy peripheral solitary pulmonary nodules that are not accessible with conventional bronchoscopy.

SPiNPerc is part of a multimodality approach that also uses endobronchial ultrasound and electromagnetic navigational bronchoscopy to diagnose and stage malignant pulmonary lesions in a one-hour minimally invasive outpatient visit. The pulmonologists at Meritas Health Pulmonary Medicine are the only physicians in the Northland performing ENB with SPiNPerc.

Three In One

Using the latest ENB technology, the Veran Thoracic Navigation System, the pulmonologists can perform all three procedures while the patient is under general anesthesia. “If we can’t get a diagnosis on a lymph node biopsy or if we don’t see anything significant in the mediastinum, we can bypass the EBUS procedure and perform the navigational bronchoscopy to get a tissue diagnosis,” explained Andrea K. Anthony, MD.

Pre-procedure inspiratory and expiratory CT scans integrated with the system’s technology give the physicians a virtual view of the patient’s bronchial airways. The system creates a 3-D roadmap from the scans, which the pulmonologists follow to guide a flexible catheter through a bronchoscope and into the bronchial tree until it reaches the nodule. An electromagnetic plate rotates over the patient and assists with tracking the catheter’s position.

To ensure an accurate diagnosis, the pulmonologists biopsy the tissue using three different GPS-equipped interchangeable devices that fit on the catheter’s tip — needle, brush, forceps. If needed, they will also employ the SPiNPerc approach.

During the procedure, a pathologist reviews the tissue samples and provides a rapid onsite evaluation. “Having the pathologist onsite during the navigational bronchoscopy is advantageous because we know immediately whether we need more tissue samples or if we’ve captured what we need to accurately diagnose and stage the cancer,” Dr. Anthony added.

SPiNPerc procedure

Added Flexibility

The option to include SPiNPerc with the ENB instantly expands the pulmonologists’ range of diagnostic tools and their ability to obtain an accurate diagnosis that can lead to early detection and faster treatment.

“SPiNPerc gives us the flexibility to transition easily from navigational bronchoscopy to a percutaneous needle biopsy during the same procedure,” Dr. Anthony said. “If we can’t reach the nodule or if the airway isn’t directly accessible, we can switch to SPiNPerc and continue obtaining a real-time diagnosis without needing to schedule a second visit.”

Dr. Anthony and her colleagues suggest primary care physicians refer patients with suspicious lesions, nodules, masses in the lungs or hilar adenopathy to a pulmonologist for evaluation. Minimally invasive procedures can biopsy lesions and reduce the patients risk of unnecessary complications or morbidities.

Other Indications

SPiNPerc technology can also be used to place fiducial markers around malignant lesions in patients who are not candidates for resection. The markers help the radiation oncology team target treatment during empiric radiation therapy.

It can also be used to inject methylene blue dye near the lesion to help the surgeon locate it during resection. For the patient, this means a much more minimally invasive resection surgery that often times can be performed robotically.