Galaxy case report, subcentimeter nodule near a branch of the pulmonary artery in the right upper lobe.

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Patient profile

A 71-year-old patient presented with a 4mm nodule in the right upper lobe (RUL) adjacent to a major branch of the pulmonary artery. The patient had a history of squamous cell carcinoma five years prior and a smoking history of 50 pack-years, which he has since quit. The nodule had been consistently positive on PET-CT scans for the past two years, but was previously assessed as having a high risk of biopsy due to its small size and proximity to a critical vessel. The nodule did not grow larger during this period but remained highly suspicious for malignancy. This was Dr. Geringer's 25th procedure using the Galaxy system.

“3D Imaging (DT) technology gave me a clear image of this 4mm nodule. Because the nodule is so close to a branch of the pulmonary artery, clear imaging was crucial for a successful biopsy. The patient had previously been told at another hospital that a biopsy couldn't be performed due to the nodule's small size. Thanks to the Galaxy system, the patient achieved early detection and treatment of non-small cell lung cancer! I am very satisfied with this technology; it is clearly paving the way for the future of robotic bronchoscopy.” — Dr. Rage Geringer, Cheyenne Regional Medical Center

          PET scan digital tomography 3D reconstruction

                Preoperative PET-CT: High-abnormality right upper lobe

                Xie's nodule (PET positive)     

Operational value

The core challenge in biopsiing sub-centimeter nodules (especially lesions near critical structures) lies in ensuring that the biopsy tool is precisely positioned within the lesion while avoiding damage to surrounding important blood vessels or structures. For these lesions, which are only 4 mm in size and located in tricky locations, high-precision positioning and safe operation are crucial.

Dr. Geringer successfully navigated to the 4mm lesion using the Galaxy system. The 3D Imaging DT reconstructed images clearly identified the lesion's boundaries and surrounding blood vessels, and the lesion's location was updated in real time. After selecting the target lesion, the Galaxy system's enhanced fluoroscopy function helped the doctor confirm that the instruments had reached the lesion from different angles using a C-arm, safely completing this challenging biopsy. Intraoperative Rapid On-Site Cytological Evaluation (ROSE) immediately indicated malignancy, and postoperative pathology confirmed squamous cell carcinoma.

Case Report

Subcentimeter nodule beside a branch of the pulmonary artery in the right upper lobe

Navigation 3D Imaging DT Scanning

The doctor navigated to the target lesion using the Galaxy system's path guidance function and then prepared to perform a 3D Imaging DT scan.

Doctors use a compatible C-arm device to perform a 60-degree rotational scan with the target lesion as the isocenter to acquire imaging data.       

Updated aiming mode and enhanced wallhacks; quick on-site assessment.

The doctor has selected the lesion, overcoming the discrepancy between CT and actual anatomy. The updated lesion location will be displayed through enhanced fluoroscopy (AF) overlay, helping the doctor to locate the lesion for biopsy while effectively avoiding critical structures.

Microscopic images of the biopsy sample: confirmed squamous cell carcinoma

diagnosis

Intraoperative rapid field cytology assessment (ROSE) suggested non-small cell lung cancer, and postoperative pathology confirmed squamous cell carcinoma.

Case Highlights

• A tiny lesion with a diameter of only 4mm was clearly visualized through 3D Imaging DT technology to reconstruct images.

• Relying on the enhanced perspective overlay function of the Galaxy system, it was confirmed from multiple angles that the tool had reached the lesion.

• Throughout the entire 20-minute surgical procedure (including the entire ROSE sampling process), the visual status of the lesion remained stable.

• A ROSE assessment indicated malignancy, and pathological results confirmed it to be squamous cell carcinoma.

• Two-dimensional C-arm imaging was used to acquire images during the operation; the entire procedure was fluoroscopic for 2 minutes and 50 seconds, with a radiation dose of only 20 mGy.

• Images and case information were provided by: Dr. Geringer (Cheyenne Regional Medical Center)

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