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Procedures: Bronchology |

Electromagnetic Navigational Bronchoscopy-Guided Diagnosis of Left Upper Lobe Spiculated Lung Nodule After Prior Right Upper Lobectomy for Non-small Cell Lung Cancer

Eric Toloza, MD; Lila Cohen, MD; Joseph Garrett, ARNP-C; Carla Moodie, PA-C; John Greene, MD
Author and Funding Information

Moffitt Cancer Center, Tampa, FL


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(4_S):A423. doi:10.1016/j.chest.2016.02.441
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SESSION TITLE: Bronchology

SESSION TYPE: Case Report Slide

PRESENTED ON: Sunday, April 17, 2016 at 02:15 PM - 03:45 PM

INTRODUCTION: Second primary lung cancer requires accurate diagnosis to avoid unnecessary lung resection after lobectomy for a first primary non-small cell lung cancer (NSCLC).

CASE PRESENTATION: A 61-year-old man, with history of positive purified protein derivative (PPD) skin test and multiple subcentimeter bilateral upper lobe lung nodules, was found to have a right upper lobe (RUL) lung nodule that enlarged from 0.6 cm to 1.3 cm over 4-1/2 months. He underwent robotic-assisted RUL wedge resection, followed by robotic-assisted completion RUL lobectomy and hilar and mediastinal lymph node (LN) dissection. Final pathology revealed 1.1-cm poorly-differentiated squamous cell carcinoma, with 2 positive level-11 LNs out of 15 total hilar and mediastinal LNs, T1N1M0, stage 2A. The patient was offered, but declined, adjuvant chemotherapy and was not candidate for pemetrexed clinical trial due to alcohol abuse. He underwent lung cancer surveillance by serial computerized tomography (CT) scans every 4-6 months. Over 3-1/2 years, a left upper lobe (LUL) spiculated lung nodule became slightly larger and denser. Rather than surgical resection or transthoracic needle biopsy for diagnosis, the patient underwent electromagnetic navigational bronchoscopy (ENB) for biopsy of the LUL lung nodule. Via 90-degree Edge catheter, ENB-guided needle aspiration, brushing, lavage, forceps biopsies revealed no evidence of malignancy, but did reveal irregular, hyposeptated, ribbon-like hyphae consistent with Zygomycetous fungi. The patient was prescribed oral voriconazole 200 mg twice daily and resumed lung cancer surveillance with serial CT scans every 6-8-months.

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