Two Cases of Peripheral Small Adenocarcinoma of the Lung Diagnosed by CT-guided Transbronchial Biopsy Using Virtual Bronchoscopy, and Treated With Stereotactic Radiotherapy

Background. We present two cases of small peripheral adenocarcinoma of the lung diagnosed by CT-guided transbronchial biopsy using an ultra-thin bronchoscope with virtual bronchoscopic navigation that were treated with stereotactic radiotherapy (SRT). Cases. Case 1: A 68-year-old man was admitted to our hospital because of acute myocardial infarction. Chest CT showed a small nodular shadow in the left S1+2b, which was 18×16 mm in size. Case 2: An 82-year-old woman had a 22×18 mm ground glass opacity (GGO) in the right S2 which was detected when she was admitted to a local hospital because of bronchitis. Both lesions were diagnosed as adenocarcinoma by CT-guided transbronchial biopsy using an ultra-thin bronchoscope with virtual bronchoscopic navigation. In both cases surgery was considered contraindicated because of heart failure in case 1 and age and multiple GGOs in case 2, and they were therefore treated with SRT. No complications or side effects were observed during the examination and treatment and no signs of recurrence have been observed so far. Conclusion. Definitive diagnoses and curable treatment with low risk are possible for patients who cannot tolerate operation by the combination of the examination and treatmentdescribed here.