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Case report: multiple lesions during navigation bronchoscopy; seen one, seen them all?

Stephan E P Kops1, Roel L J Verhoeven1, Erik F M van der Heijden1

  • 1Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.

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Summary

Cone-beam CT guided navigation bronchoscopy enables sampling of multiple pulmonary nodules in one session. This technique proved invaluable in diagnosing three synchronous primary lung tumors, each requiring distinct treatments, in a single patient.

Keywords:
Case reportcone beam CT navigation bronchoscopymulti-modality treatmentsynchronous tumors

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Area of Science:

  • Pulmonology
  • Oncology
  • Radiology

Background:

  • Multiple peripheral pulmonary nodules are frequently diagnosed, but traditional biopsies often sample only one.
  • Computed tomography (CT) guided transthoracic biopsy (TTNB) is standard but limited in sampling multiple lesions.
  • Navigation bronchoscopy offers a minimally invasive approach with low complication rates and advanced imaging for multi-lesion sampling.

Observation:

  • A case study involving an asymptomatic patient with multiple pulmonary nodules detected on screening X-ray.
  • Positron emission tomography (PET) and CT scans identified two nodules, leading to a navigation bronchoscopy procedure.
  • During bronchoscopy, a third occult endobronchial lesion was discovered, resulting in the diagnosis of three synchronous primary lung tumors.

Findings:

  • Pathology confirmed three distinct primary lung tumors in the same patient.
  • Each tumor was treated with a different modality: surgery, radiotherapy, and endobronchial cryoablation.
  • Cone-beam CT guided navigation bronchoscopy (CBCT-NB) was crucial for the comprehensive diagnostic work-up.

Implications:

  • Synchronous primary lung malignancies necessitate individualized treatment strategies to improve survival and minimize morbidity.
  • Image-guided navigation bronchoscopy facilitates thorough diagnostic evaluation and can be integrated with endobronchial ultrasound (EBUS) for staging in a single session.
  • This approach highlights the potential of advanced bronchoscopic techniques in managing complex lung cancer cases.