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Wang K, Huang W, Chen X, Li G, Li N, Huang X, Liao X, Song J, Yang Q, He K, An Y, Feng X, Zhang Z, Chi C, Tian J, Chen F, Chen F. Efficacy of Near-Infrared Fluorescence Video-Assisted Thoracoscopic Surgery for Small Pulmonary Nodule Resection with Indocyanine Green Inhalation: A Randomized Clinical Trial. Ann Surg Oncol 2023; 30:5912-5922. [PMID: 37389655 DOI: 10.1245/s10434-023-13753-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 06/01/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Small pulmonary nodules (<3 cm) can sometimes be unrecognizable and nonpalpable in video-assisted thoracoscopic surgery (VATS). Near-infrared fluorescence (NIF) VATS after indocyanine green (ICG) inhalation may effectively guide surgeons to locate the nodules. OBJECTIVE This study aimed to investigate the safety, feasibility, and efficacy of ICG inhalation-based NIF imaging for guiding small pulmonary nodule resections. METHODS Between February and May 2021, the first-stage, non-randomized trial enrolled 21 patients with different nodule depth, ICG inhalation doses, post-inhalation surgery times, and nodule types at a tertiary referral hospital. Between May 2021 and May 2022, the second-stage randomized trial enrolled 56 patients, who were randomly assigned to the fluorescence VATS (FLVATS) or the white-light VATS (WLVATS) group. The ratio of effective guidance and the time consumption for nodule localization were compared. RESULTS The first-stage trial proved this new method is safe and feasible, and established a standardized protocol with optimized nodule depth (≤1 cm), ICG dose (0.20-0.25 mg/kg), and surgery window (50-90 min after ICG inhalation). In the second-stage trial, the FLVATS achieved 87.1% helpful nodule localization guidance, which was significantly higher than the WLVATS (59.1%, p < 0.05). The mean nodule locating time (standard deviation) was 1.8 [0.9] and 3.3 [2.3] min, respectively. Surgeons adopting FLVATS were significantly faster (p < 0.01), especially when locating small ground-glass opacities (1.3 [0.6] min vs. 7.0 [3.5] min, p < 0.05). Five of 31 nodules (16.1%) were only detectable by FLVATS, whereas both white light and palpation failed. CONCLUSIONS This new method is safe and feasible for small pulmonary nodule resection. It significantly improves nodule localization rates with less time consumption, and hence is highly worthy for clinical promotion. Clinical Trial Registration Chinese Clinical Trial Registry Identifier: ChiCTR2100047326.
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Affiliation(s)
- Kun Wang
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, Hainan Province, China
- CAS Key Laboratory and Beijing Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Weiyuan Huang
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, Hainan Province, China
| | - Xianshan Chen
- Department of Thoracic Surgery, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, Hainan Province, China
| | - Gao Li
- Department of Thoracic Surgery, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, Hainan Province, China
| | - Na Li
- Department of Anesthesiology, Hainan General Hospital (Affiliated Hainan Hospital of Hainan Medical University), Haikou, Hainan, China
| | - Xiuming Huang
- Department of Thoracic Surgery, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, Hainan Province, China
| | - Xuqiang Liao
- Department of Thoracic Surgery, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, Hainan Province, China
| | - Jiali Song
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, Hainan Province, China
| | - Qianyu Yang
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, Hainan Province, China
| | - Kunshan He
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine and Engineering, Beihang University, Beijing, China
| | - Yu An
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine and Engineering, Beihang University, Beijing, China
| | - Xin Feng
- CAS Key Laboratory and Beijing Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Zeyu Zhang
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine and Engineering, Beihang University, Beijing, China
| | - Chongwei Chi
- CAS Key Laboratory and Beijing Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Jie Tian
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, Hainan Province, China.
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine and Engineering, Beihang University, Beijing, China.
| | - Fengxia Chen
- Department of Thoracic Surgery, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, Hainan Province, China.
| | - Feng Chen
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, Hainan Province, China.
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Yu H, Tian W, Sun Y, Wu Q, Ma C, Jiao P, Huang C, Li D, Tong H. Localization of small peripheral pulmonary nodules for surgical resection: a new intraoperative technique in hybrid operating room. J Cardiothorac Surg 2022; 17:241. [PMID: 36176000 PMCID: PMC9524030 DOI: 10.1186/s13019-022-02012-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 09/27/2022] [Indexed: 11/28/2022] Open
Abstract
Objective The purpose of this study was to introduce a new feasible and effective intraoperative localization technique for small peripheral pulmonary nodules in hybrid operating room. Methods Between June 2020 and June 2021, the intraoperative localization was performed in 27 patients for 35 small pulmonary nodules at our institution. The procedure was undergone under thoracoscopic observation. After making the VATS ports, a titanium clip was clipped at the visceral pleura as near the pulmonary nodule as possible to be a marker for the nodule. VATS resection was performed next. Results A total of 27 patients were included in this study, including 6 males and 21 females. The median age was 58 years (range 34–78 years). All surgeries were performed by two-port VATS. A total of 35 pulmonary nodules underwent intraoperative localization. The mean diameter of nodules was 10.6 ± 3.7 mm. The distance of nodules to visceral pleura was 8.3 ± 8.7 mm. The mean localization time was 23.3 ± 3.3 min. The median time of C-arm scanning was 3 (range 2–4) times. The median times for clipping were 2 (range 1–3) times. All the nodules were localized successfully and resected precisely. No VATS were converted to thoracotomy. There were no complications related to localization procedures. Conclusions This new intraoperative localization technique was feasible, safe and effective. And also the intraoperative procedure could avoid extra suffering for patients.
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Affiliation(s)
- Hanbo Yu
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Wenxin Tian
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Yaoguang Sun
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Qingjun Wu
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Chao Ma
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Peng Jiao
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Chuan Huang
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Donghang Li
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Hongfeng Tong
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Dong Dan, Beijing, 100730, People's Republic of China.
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Efficacy and Safety Analysis of Multislice Spiral CT-Guided Transthoracic Lung Biopsy in the Diagnosis of Pulmonary Nodules of Different Sizes. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8192832. [PMID: 36060660 PMCID: PMC9436531 DOI: 10.1155/2022/8192832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/14/2022] [Accepted: 07/26/2022] [Indexed: 11/23/2022]
Abstract
Objective This study is aimed at investigating the efficacy and safety of multislice spiral CT-guided transthoracic lung biopsy in the diagnosis of pulmonary nodules of different sizes. Methods Data of 78 patients with pulmonary nodules who underwent CT-guided transthoracic lung biopsy in our hospital from January 2020 to December 2021 were retrospectively analyzed, and they were divided into the small nodules group (n = 12), medium nodules group (n = 35), and large nodules group (n = 31) according to the diameter of pulmonary nodules. The results of puncture biopsy and final diagnosis of pulmonary nodules of different sizes were compared. The incidence of complications in patients with pulmonary nodules of different sizes was compared. Univariate analysis was used to compare the incidence of complications in 78 patients. Logistic multiple regression analysis was used to analyze the independent risk factors of pneumothorax in patients with pulmonary nodule puncture. Logistic multiple regression analysis was used to analyze the independent risk factors of pulmonary hemorrhage in patients with pulmonary nodule puncture. Results The diagnostic accuracy, sensitivity, and specificity were 83.33%, 100.00%, and 77.78% in small nodules group. The diagnostic accuracy, sensitivity, and specificity of medium nodules group were 85.71%, 100.00%, and 73.68%, respectively. The diagnostic accuracy, sensitivity, and specificity of large nodules group were 93.55%, 100.00%, and 33.33%, respectively. There was no significant difference in the incidence of pneumothorax among the three groups (P > 0.05). The incidence of pulmonary hemorrhage in small nodule group was higher than that in the medium nodule group and large nodule group, and the difference was statistically significant (P < 0.05). There was no significant difference in the incidence of total complications among the three groups (P > 0.05). There were statistically significant differences in clinical data such as the needle tract length, the puncture position, and the distance of the puncture needle passing through the lung tissue in patients with or without pneumothorax (P < 0.05). There were statistically significant differences in needle tract length, distance of puncture needle passing through lung tissue, and size of pulmonary nodules in patients with or without pulmonary hemorrhage (P > 0.05). Logistic multivariate analysis showed that needle tract length ≤ 50 mm, lateral decubitus position, and the distance of puncture needle passing through lung tissue ≥ 14 mm were independent risk factors for pneumothorax after puncture in patients with pulmonary nodules (P < 0.05). The needle tract length > 50 mm, the distance of puncture needle passing through lung tissue ≥ 14 mm, and small nodules (pulmonary nodules diameter ≤ 10 mm) were independent risk factors for pulmonary hemorrhage after puncture in patients with pulmonary nodules (P < 0.05). Conclusion Multislice spiral CT-guided transthoracic lung biopsy is effective in diagnosing pulmonary nodules of different sizes.
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Fra-Fernández S, Gorospe-Sarasúa L, Ajuria-Illarramendi O, Serrano-Carvajal PE, Muñoz-Molina GM, Cabañero-Sánchez A, Rioja-Martin ME, Moreno-Mata N. Preoperative radio-guided localization of lung nodules with I-125 seeds: experience with 32 patients at a single institution. Interact Cardiovasc Thorac Surg 2022; 34:91-98. [PMID: 34999800 PMCID: PMC8923417 DOI: 10.1093/icvts/ivab223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/04/2021] [Accepted: 07/13/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Videothoracoscopic visualization and/or palpation of pulmonary nodules may be difficult due to their location, small size or limited solid component. The purpose of this study is to present our experience with computed tomography (CT)-guided preoperative localization of pulmonary nodules by percutaneous marking with radio-labelled iodine-125 seeds. METHODS A total of 34 pulmonary nodules were marked under CT with the placement of 33 radio-labelled iodine-125 seeds in 32 consecutive patients. RESULTS All patients underwent biportal video-assisted thoracic surgery (VATS) and in no case was conversion to thoracotomy necessary. A total of 88.2% of the lung nodules were successfully resected. In the remaining 11.8%, migration of the seed to the pleural cavity occurred, although these nodules were still resected during VATS. Of all the patients with pneumothorax after the marking procedure, only one required chest tube placement (3.1%). No major postoperative complications were observed. CONCLUSIONS Preoperative marking of pulmonary nodules with I-125 seeds under CT guidance is a feasible and safe technique that allows their intraoperative identification and resection.
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Affiliation(s)
- Sara Fra-Fernández
- Department of Thoracic Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | | | | | | | - Nicolás Moreno-Mata
- Department of Thoracic Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Wu G, Wu X, Xu M. [Preoperative Pulmonary Nodule Localization Methods:A Comparison of Microcoil and Sclerosing Agent]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:429-435. [PMID: 32517445 PMCID: PMC7309542 DOI: 10.3779/j.issn.1009-3419.2020.102.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
背景与目的 肺内小结节往往难以进行胸腔镜术中定位,需要术前计算机断层扫描(computed tomography, CT)引导经皮穿刺定位辅助,本研究旨在比较两种不同定位材料即微弹簧圈和硬化剂(聚桂醇)定位的效果及相关并发症,评价优劣。 方法 回顾性分析术前CT引导经皮穿刺定位患者371例,根据采用的不同定位材料分为:微弹簧圈组(microcoil group)167例,定位结节196枚、硬化剂组(sclerosing agent group)204例,定位结节239枚。统计分析两组定位效果、并发症、病理资料及手术方案等相关资料。 结果 微弹簧圈组定位失败率(2.4%)高于硬化剂组(0.5%)(P=0.011),硬化剂定位耗时明显短于微弹簧圈组[(18.78±6.91)min vs(11.99±3.77)min, P=0.000],但微弹簧圈组较硬化剂组选择定位结节与胸膜间距离更深[(9.59±8.62)mm vs(8.13±6.49)mm, P=0.002]。总体并发症上微弹簧圈组显著高于硬化剂组(P=0.000),其中以气胸为主,通过相关危险因素分析提示不同定位方法是独立危险因子。手术方式以楔形切除为主,病理结果以非浸润性病变为主。 结论 微弹簧圈与硬化剂均是良好的术前定位材料,聚桂醇硬化剂较之微弹簧圈定位失败率更低、并发症更少,定位时长更短,操作简便且费用低廉,值得推广。
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Affiliation(s)
- Gao Wu
- Department of Thoracic Surgery, the First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital), Hefei 230001, China
| | - Xianning Wu
- Department of Thoracic Surgery, the First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital), Hefei 230001, China
| | - Meiqing Xu
- Department of Thoracic Surgery, the First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital), Hefei 230001, China
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Yang F, Zhao H, Sui X, Zhang X, Sun Z, Zhao X, Wang J. Comparative study on preoperative localization techniques using microcoil and hookwire by propensity score matching. Thorac Cancer 2020; 11:1386-1395. [PMID: 32207226 PMCID: PMC7262885 DOI: 10.1111/1759-7714.13365] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/04/2020] [Accepted: 02/07/2020] [Indexed: 12/17/2022] Open
Abstract
Background The purpose of this study was to compare the efficacy and safety of two preoperative pulmonary nodule localization techniques using microcoil and hookwire. Methods A total of 307 patients with 324 pulmonary nodules were included in the study from March 2012 to October 2016 in two medical centers. Baseline data, positioning operation data, success rate, complications, surgery and pathological results were statistically analyzed. Complications were used as the dependent variables, whereas others were used as covariates for the propensity score matching of the two groups. Statistical analyses were performed to compare the success rate and complication rate of the matched groups. Results There were 218 lesions in the microcoil group and 106 nodules in the hookwire group. There were no significant differences in gender, age and the location of nodules between the two groups. The diameters of the nodules were smaller (8.2 ± 3.5 mm vs. 10.7 ± 4.3 mm) and solid nodules were fewer (11.5% vs. 26.4%) in the microcoil group. The complication rate of the two groups was not statistically significant. After propensity score matching, 71 patients in each group were successfully matched. We found that the success rate was higher (97.2% vs. 94.4%) and the incidence of complications was lower (31% vs. 15.5%) in the microcoil group. Conclusions Both techniques have been shown to be effective in preoperative localization of tiny pulmonary nodules. The method of microcoil localization has more advantages in clinical application. Key points Comparison of the efficacy and safety of two methods in preoperative pulmonary nodule localization in order to determine the optimal method.
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Affiliation(s)
- Feng Yang
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, Beijing, China
| | - Hui Zhao
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, Beijing, China
| | - Xizhao Sui
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, Beijing, China
| | - Xugang Zhang
- Department of Thoracic Surgery, Shijitan Hospital, Beijing, China
| | - Zewen Sun
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, Beijing, China
| | - Xiaoyi Zhao
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, Beijing, China
| | - Jun Wang
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, Beijing, China
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Jiang T, Lin M, Zhao M, Zhan C, Li M, Feng M, Wang Q. Preoperative Computed Tomography-Guided Localization for Pulmonary Nodules with Glue and Dye. Thorac Cardiovasc Surg 2020; 68:525-532. [PMID: 32114690 DOI: 10.1055/s-0039-3400999] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND This study was aimed to describe a new localization technique developed using medical glue and methylene blue dye, and characterized the localization results and postoperative outcome to evaluate its safety and usefulness. METHODS This retrospective study was conducted at our center from January 2016 to April 2018. Totally 346 consecutive patients with 383 nodules who underwent preoperative computed tomography (CT)-guided medical glue and methylene blue dye localization, followed by lung resection, were enrolled in this study. RESULTS Mean nodule size was 7.7 ± 3.7 mm (range: 2-30 mm), with a mean depth from pleura or fissure of 9.4 ± 9.3 mm (range: 0-60 mm). The success rate of CT-guided localization for pulmonary nodules was 99.5% (381/383) of the nodules. Localization-related complications included mild pneumothorax in 16 (4.6%) patients, mild hemothorax in 7 (2.0%) patients, and hemoptysis in 1 (0.3%) patient. Pleural reaction occurred in 7 (2.0%) and pain in 25 (7.2%) patients. All 383 nodules were resected successfully, with conversion to thoracotomy only required in two patients for adhesion and calcification of lymph nodes. All patients recovered well postoperatively, with a short postoperative hospital stay (3.7 ± 2.0 days) and a low complication rate (2.6%, 9/346). CONCLUSION CT-guided medical glue and methylene blue dye localization prior to video-assisted thoracoscopic surgery (VATS) lung resection was a novel, safe, and technically feasible method, with a high-technical success rate and a low-complication rate. It allowed surgeons to easily locate and detect the nodules and estimate the surgical margin.
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Affiliation(s)
- Tian Jiang
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Miao Lin
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Mengnan Zhao
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Cheng Zhan
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Ming Li
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Mingxiang Feng
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
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Patella M, Bartolucci DA, Mongelli F, Cartolari R, Minerva EM, Inderbitzi R, Cafarotti S. Spiral wire localization of lung nodules: procedure effectiveness and oncological usefulness. J Thorac Dis 2019; 11:5237-5246. [PMID: 32030241 DOI: 10.21037/jtd.2019.11.74] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background In the last years, a large number of techniques and devices for localizing small pulmonary nodules prior to resection have been developed with the aim of facilitating minimally invasive surgery (VATS). However, each device presents pros and cons and there is no unanimous consensus. We report our experience with an uncommon wire system with spiral shape for percutaneous marking. Methods We recorded 102 consecutive CT-guided spiral wire localizations in our Institution, and we evaluated the efficacy of the method according to 4 success rates (SR): (I) successful targeting rate (SR-1): number of successful targeting procedures/number of all localizations; (II) successful localization in operative field (SR-2): (number of successful targeting procedures -number of dislodgements in operative field)/number of all localizations; (III) successful VATS rate (SR-3): number of successful VATS procedures/(number of localizations-number of thoracotomies not due to wire dislocation); (IV) successful curative rate (SR-4): number of neoplastic nodules resected with curative intent with free margins (R0) on definitive tissue diagnosis/number of neoplastic nodules resected with curative intent. Complications rate was recorded as well. Results SR-1: 100%, SR-2: 97.1%, SR-3: 100%, SR-4: 100%. Asymptomatic pneumothorax and minimal parenchymal hemorrhage were observed in 5 (4.9%) and 19 (18.6%) cases, respectively. Conclusions Spiral wire localization showed very good results in terms of feasibility, stability in operative field and contributed to effective use of VATS during wedge resection performed for malignant nodules. In the era of widespread radiological investigations (as it is happening in lung cancer screening) and evolutions in cancer treatments, this appears to be clinically relevant.
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Affiliation(s)
- Miriam Patella
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland
| | | | - Francesco Mongelli
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland
| | - Roberto Cartolari
- Service of Radiology, San Giovanni Hospital, Bellinzona, Switzerland
| | | | - Rolf Inderbitzi
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland
| | - Stefano Cafarotti
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland
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Zhao G, Yu X, Chen W, Geng G, Li N, Liu H, Yin P, Sun L, Jiang J. Computed tomography-guided preoperative semi-rigid hook-wire localization of small pulmonary nodules: 74 cases report. J Cardiothorac Surg 2019; 14:149. [PMID: 31426812 PMCID: PMC6701050 DOI: 10.1186/s13019-019-0958-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/15/2019] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES The study aimed to retrospectively evaluate the success rate, utility, practicality and results of pre-operative CT (computed tomography)-guided semi-rigid single hook-wire placement and the pathology results of small pulmonary nodules (SPN). MATERIALS AND METHODS Seventy-four patients with 81 small pulmonary nodules underwent CT-guided semi-rigid single hook wire localization consecutively between 2016 and 2017 were reviewed. VATS (video-assisted thoracoscopic surgery) resection of lung tissue containing each pulmonary nodule and were performed in the direction of hook wire. The success rate and utility of the localization, hook wire related complications, the histopathology of SPN are analyzed. RESULTS The semi-rigid hook wire was performed successfully in all 81 small pulmonary nodules within mean time of 10 min (8-13 min, SD: 1.58 min). Compared with solid nodules, GGOs (ground-glass opacity) were more frequently malignant (p < 0.05), with an OR (odds ratio) 8.59 (95%CI, 0.967, 412.845). Of the pure GGOs, 9 (25%) nodules were classified as AIS, 10 (27.8%) nodules were classified as MIA and 22 (57.9%) of the mGGOs were lung cancer. According to multivariate analysis, the malignant hazard was as high as 6.533-fold higher in nodules with a size larger than 10 mm compared with those smaller than 10 mm. GGOs with tiny blood vessels showed a statistically significant correlation with malignancy. Surprisingly, no statistically significant difference in the incidence of lung cancer in age. No major complication occurred. CONCLUSIONS Preoperative localization of small pulmonary nodules using semi-rigid single hook wire was found to be practical and safe, which allows for proper diagnosis. Incidental small pulmonary nodule, especially GGO larger than 10 mm needs to be taken seriously.
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Affiliation(s)
- Guang Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital of Xiamen University, 55 Zhenhai Rd., Xiamen, 361003, China
| | - Xiuyi Yu
- Department of Thoracic Surgery, The First Affiliated Hospital of Xiamen University, 55 Zhenhai Rd., Xiamen, 361003, China.
| | - Weiqiang Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Xiamen University, 55 Zhenhai Rd., Xiamen, 361003, China
| | - Guojun Geng
- Department of Thoracic Surgery, The First Affiliated Hospital of Xiamen University, 55 Zhenhai Rd., Xiamen, 361003, China
| | - Ning Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Xiamen University, 55 Zhenhai Rd., Xiamen, 361003, China
| | - Hongming Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of Xiamen University, 55 Zhenhai Rd., Xiamen, 361003, China
| | - Pan Yin
- Department of Thoracic Surgery, The First Affiliated Hospital of Xiamen University, 55 Zhenhai Rd., Xiamen, 361003, China
| | - Long Sun
- Department of Nuclear Medicine, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Jie Jiang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xiamen University, 55 Zhenhai Rd., Xiamen, 361003, China.
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Sun W, Zhang L, Wang L, Ren Y, She Y, Su H, Jiang G, Chen C. Three-Dimensionally Printed Template for Percutaneous Localization of Multiple Lung Nodules. Ann Thorac Surg 2019; 108:883-888. [PMID: 31009631 DOI: 10.1016/j.athoracsur.2019.03.060] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/21/2019] [Accepted: 03/18/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND When multiple target lung nodules exist, the computed tomography (CT)-guided percutaneous localization procedure becomes complicated. In this study, a three-dimensional (3D)-printed template was designed that could guide hook wire localization of multiple lung nodules. The pilot study aimed for preliminary validation of the feasibility of template-guided localization for multiple lesions. METHODS Patients with multiple lung nodules (<2 cm) and who were scheduled for surgical resection were recruited for participation in this study. After securing their preadmission CT images, the study investigators reconstructed a 3D thorax model from which they designed a digital model as a navigational template. A physical template was then printed for guiding the percutaneous localization of lung nodules. The localization accuracy was evaluated on the basis of the deviation between the localizer and the nodule. RESULTS From April 2018 to November 2018, the study enrolled 16 patients with 34 lung nodules. All nodules were successfully localized under template guidance, with a median procedural time of 10.0minutes (interquartile range [IQR], 8.5-12.6 minutes) and a median radiation exposure of 235 mGy • cm (IQR, 195-254 mGy • cm). The median deviation from the hook wires and nodule centers was 9.0 mm (IQR, 6.2-11.8 mm). Except for 2 cases of pneumothorax without need for further intervention, no complications occurred. CONCLUSIONS Navigational templates built using 3D printing may serve as an effective approach for facilitating localization of multiple lung nodules.
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Affiliation(s)
- Weiyan Sun
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lei Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Long Wang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yijiu Ren
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yunlang She
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hang Su
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
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Huang BY, Zhou JJ, Song XY, Wu JH, Zheng D, Li XM, Li L. Clinical analysis of percutaneous computed tomography-guided injection of cyanoacrylate for localization of 115 small pulmonary lesions in 113 asymptomatic patients. J Int Med Res 2019; 47:2145-2156. [PMID: 30966824 PMCID: PMC6567758 DOI: 10.1177/0300060518822229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective This study was performed to assess the clinical feasibility, safety, and effectiveness of a computed tomography (CT)–guided cyanoacrylate injection system and investigate the relationship between clinical features and pathologic characteristics of diminutive pulmonary lesions. Methods In total, 115 pulmonary nodules from 113 patients (63 female, 50 male) with a diameter of <20 mm were percutaneously localized with a CT-guided cyanoacrylate injection system and then resected. Results Of the pure ground-glass opacities (GGOs), 16.0% were atypical adenomatous hyperplasia (AAH), 18.7% were adenocarcinoma in situ (AIS), 49.3% were lung adenocarcinoma (ADC), and 16.0% were benign inflammatory fibrosis/fibrotic scars. Of the mixed GGOs, 18.2% were AAH, 22.7% were AIS, 22.7% were ADC, and 36.4% were benign lesions. Lesions of >10 mm and those located in relation to vessels were significantly more likely to be malignant. The success rate of both the cyanoacrylate injection system and video-assisted thoracoscopic surgery was 100% with no severe complications. Conclusions Preoperative localization of small pulmonary nodules using a cyanoacrylate injection system is a safe, simple, and useful technique.
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Affiliation(s)
- Bing-Yang Huang
- 1 Department of Cardiothoracic Surgery, The 306th Hospital of PLA, Chao-yang District, Beijing, People's Republic of China
| | - Jun-Jun Zhou
- 1 Department of Cardiothoracic Surgery, The 306th Hospital of PLA, Chao-yang District, Beijing, People's Republic of China
| | - Xiao-Yong Song
- 1 Department of Cardiothoracic Surgery, The 306th Hospital of PLA, Chao-yang District, Beijing, People's Republic of China
| | - Ji-Hua Wu
- 2 Department of Pathology, The 306th Hospital of PLA, Chao-yang District, Beijing, People's Republic of China
| | - Dong Zheng
- 3 Department of Radiology, The 306th Hospital of PLA, Chao-yang District, Beijing, People's Republic of China
| | - Xin-Ming Li
- 1 Department of Cardiothoracic Surgery, The 306th Hospital of PLA, Chao-yang District, Beijing, People's Republic of China
| | - Lu Li
- 1 Department of Cardiothoracic Surgery, The 306th Hospital of PLA, Chao-yang District, Beijing, People's Republic of China
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Zhang C, Lin H, Fu R, Zhang T, Nie Q, Dong S, Yang XN, Wu YL, Zhong WZ. Application of indocyanine green fluorescence for precision sublobar resection. Thorac Cancer 2019; 10:624-630. [PMID: 30734507 PMCID: PMC6449268 DOI: 10.1111/1759-7714.12972] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Increasing identification of small pulmonary nodules promotes sublobar resection, but localization and surgical margins of non-palpable pulmonary nodules through sublobar resection are challenging. Our aim was explicate the feasibility of applying indocyanine green (ICG) fluorescence to localized nodules, and to carry out surgical resection. METHODS A total of 46 patients with subpleural pulmonary nodules <3 cm were enrolled, including 35 for wedge resection and 11 for segmentectomy. For wedge resection, patients underwent computed tomography-guided percutaneous injection of ICG preoperatively. Wedge resection was carried out after confirmation of the fluorescence using fluoroscopy. For segmentectomy, ICG was injected through the peripheral vein during surgery and resection of the segmental plain was carried out. Detailed measurements were taken and information was collected for the whole procedure. RESULTS A total of 33 out of 35 patients underwent successful wedge resection using ICG fluorescence. Segmentectomy was successfully carried out for all 11 patients who underwent the procedure. For two patiens, the nodules failed to be localized with unclear fluorescence, and one patient with an undetected nodule was altered to perform lobectomy. For wedge resection, the mean tumor size and depth from the pleural surface were 7.8 ± 0.5 mm and 10.5 ± 1.6 mm, respectively. The median time taken for preoperative computed tomography-guided percutaneous injection was 28 min (range 18-40 min), and 25 min (range 16-30 min) for wedge resection. For segmentectomy, the ICG fluorescence occurred 14 s after injecting ICG through the peripheral vein, and the median duration was 15 min. All surgical margins were negative based on pathological evaluation. CONCLUSIONS The implementation of ICG fluorescence could provide surgeons carrying out precision sublobar resection with a time-saving surgical technique with less unnecessary intraoperative damage.
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Affiliation(s)
- Chao Zhang
- School of Medicine, South China University of Technology, Guangzhou, China.,Department of Thoracic Oncology, Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Huan Lin
- Department of Breast Cancer, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Rui Fu
- Department of Thoracic Oncology, Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Tao Zhang
- Department of Thoracic Oncology, Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qiang Nie
- Department of Thoracic Oncology, Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Song Dong
- Department of Thoracic Oncology, Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xue-Ning Yang
- Department of Thoracic Oncology, Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yi-Long Wu
- Department of Thoracic Oncology, Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wen-Zhao Zhong
- Department of Thoracic Oncology, Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
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Shen C, Li P, Li J, Che G. [Advancement of Common Localization of Solitary Pulmonary Nodules
for Video-assisted Thracoscopic Surgery]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:628-634. [PMID: 30172271 PMCID: PMC6105347 DOI: 10.3779/j.issn.1009-3419.2018.08.09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
最近,伴随着高分辨多层电子计算机断层扫描(computed tomography, CT)的大量普及,肺小结节的诊断也日益增多,尤其是在伴有肺癌高危因素的患者行CT筛查时尤为明显。电视辅助胸腔镜手术对于肺小结节的诊断和治疗提供了一种全新的微创治疗方式,胸腔镜手术后给患者带来的疼痛感减少、住院时间缩短、手术并发症减少等特点,使其推广更为广泛。如何精准定位及标记病灶,以助电视胸腔镜下切除病灶的方法层出不穷。本文综述近年来胸腔镜下肺小结节定位的各种技术手段,并对各种方法的利弊进行总结及分析。
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Affiliation(s)
- Cheng Shen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Pengfei Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jue Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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Preoperative localisation of pulmonary ground-glass opacity using medical adhesive before thoracoscopic resection. Eur Radiol 2018; 28:4048-4052. [DOI: 10.1007/s00330-018-5394-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 02/05/2018] [Accepted: 02/20/2018] [Indexed: 10/17/2022]
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Computed Tomography-Assisted Thoracoscopic Surgery: A Novel, Innovative Approach in Patients With Deep Intrapulmonary Lesions of Unknown Malignant Status. Invest Radiol 2018; 52:374-380. [PMID: 28141614 DOI: 10.1097/rli.0000000000000353] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Minimally invasive resection of small, deep intrapulmonary lesions can be challenging due to the difficulty of localizing them during video-assisted thoracoscopic surgery (VATS). We report our preliminary results evaluating the feasibility of an image-guided, minimally invasive, 1-stop-shop approach for the resection of small, deep intrapulmonary lesions in a hybrid operating room (OR). MATERIALS AND METHODS Fifteen patients (5 men, 10 women; mean age, 63 years) with a total of 16 solitary, deep intrapulmonary nodules of unknown malignant status were identified for intraoperative wire marking. Patients were placed on the operating table for resection by VATS. A marking wire was placed within the lesion under 3D laser and fluoroscopic guidance using a cone beam computed tomography system. Then, wedge resection by VATS was performed in the same setting without repositioning the patient. RESULTS Complete resection with adequate safety margins was confirmed for all lesions. Marking wire placement facilitated resection in 15 of 16 lesions. Eleven lesions proved to be malignant, either primary or secondary; 5 were benign. Mean lesion size was 7.7 mm; mean distance to the pleural surface was 15.1 mm (mean lesion depth-diameter ratio, 2.2). Mean procedural time for marking wire placement was 35 minutes; mean VATS duration was 36 minutes. CONCLUSIONS Computed tomography-assisted thoracoscopic surgery is a new, safe, and effective procedure for minimally invasive resection of small, deeply localized intrapulmonary lesions. The benefits of computed tomography-assisted thoracoscopic surgery are 1. One-stop-shop procedure, 2. Lower risk for the patient (no patient relocation, no marking wire loss), and 3. No need to coordinate scheduling between the CT room and OR.
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Yang J, Wang H, Geng C, Dai Y, Ji J. Advances in intelligent diagnosis methods for pulmonary ground-glass opacity nodules. Biomed Eng Online 2018; 17:20. [PMID: 29415726 PMCID: PMC5803858 DOI: 10.1186/s12938-018-0435-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/10/2018] [Indexed: 02/06/2023] Open
Abstract
Pulmonary nodule is one of the important lesions of lung cancer, mainly divided into two categories of solid nodules and ground glass nodules. The improvement of diagnosis of lung cancer has significant clinical significance, which could be realized by machine learning techniques. At present, there have been a lot of researches focusing on solid nodules. But the research on ground glass nodules started late, and lacked research results. This paper summarizes the research progress of the method of intelligent diagnosis for pulmonary nodules since 2014. It is described in details from four aspects: nodular signs, data analysis methods, prediction models and system evaluation. This paper aims to provide the research material for researchers of the clinical diagnosis and intelligent analysis of lung cancer, and further improve the precision of pulmonary ground glass nodule diagnosis.
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Affiliation(s)
- Jing Yang
- School of Biomedical Engineering, University of Science and Technology of China, Hefei, 230026 People’s Republic of China
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, 215163 People’s Republic of China
| | - Hailin Wang
- Radiology Department and Interventional Radiology Center, The Fifth Affiliated Hospital of Wenzhou Medical University, Affiliated Lishui Hospital of Zhejiang University, The Central Hospital of Zhejiang Lishui, Lishui, 323000 People’s Republic of China
| | - Chen Geng
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, 215163 People’s Republic of China
| | - Yakang Dai
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, 215163 People’s Republic of China
| | - Jiansong Ji
- Radiology Department and Interventional Radiology Center, The Fifth Affiliated Hospital of Wenzhou Medical University, Affiliated Lishui Hospital of Zhejiang University, The Central Hospital of Zhejiang Lishui, Lishui, 323000 People’s Republic of China
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Chen X, Li H. Reply to comments on " Robotic Assisted Right Middle Lobectomy": incision positions, approaches and other problems. J Thorac Dis 2017; 9:E962-E963. [PMID: 29266115 DOI: 10.21037/jtd.2017.10.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Xingshi Chen
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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Management of Progressive Pulmonary Nodules Found during and outside of CT Lung Cancer Screening Studies. J Thorac Oncol 2017; 12:1755-1765. [DOI: 10.1016/j.jtho.2017.09.1956] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 09/08/2017] [Accepted: 09/14/2017] [Indexed: 12/17/2022]
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Zhao G, Sun L, Geng G, Liu H, Li N, Liu S, Hao B, Yu X, Jiang J. Semi-rigid single hook localization the best method for localizing ground glass opacities during video-assisted thoracoscopic surgery: re-aerated swine lung experimental and primary clinical results. J Thorac Dis 2017; 9:5161-5170. [PMID: 29312722 DOI: 10.21037/jtd.2017.11.58] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background The aim of this study was to compare the effects of currently available preoperative localization methods, including semi-rigid single hook-wire, double-thorn hook-wire, and microcoil, in localizing the pulmonary nodules, thus to select the best technology to assist video-assisted thoracoscopic surgery (VATS) for small ground glass opacities (GGO). Methods Preoperative CT-guided localizing techniques including semi-rigid single hook-wire, double-thorn hook-wire and microcoil were used in re-aerated fresh swine lung for location experiments. The advantages and drawbacks of the three positioning technologies were compared, and then the most optimal technique was used in patients with GGO. Technical success and post-operative complications were used as primary endpoints. Results All three localizing techniques were successfully performed in the re-aerated fresh swine lung. The median tractive force of semi-rigid single hook wire, double-thorn hook wire and microcoil were 6.5, 4.85 and 0.2 N, which measured by a spring dynamometer. The wound sizes in the superficial pleura, caused by unplugging the needles, were 2 mm in double-thorn hook wire, 1 mm in semi-rigid single hook and 1 mm in microcoil, respectively. In patients with GGOs, the semi-rigid hook wires localizations were successfully performed, without any complication that need to be intervened. Dislodgement was reported in one patient before VATS. No major complications related to the preoperative hook wire localization and VATS were observed. Conclusions We found from our localization experiments in the swine lung that, among the commonly used three localization methods, semi-rigid hook wire showed the best operability and practicability than double-thorn hook wire and microcoil. Preoperative localization of small pulmonary nodules with single semi-rigid hook wire system shows a high success rate, acceptable utility and especially low dislodgement in VATS.
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Affiliation(s)
- Guang Zhao
- Department of Thoracic Surgery, the First Affiliated Hospital of Xiamen University, Xiamen 361003, China
| | - Long Sun
- Department of Nuclear Medicine, the First Affiliated Hospital of Xiamen University, Xiamen 361003, China
| | - Guojun Geng
- Department of Thoracic Surgery, the First Affiliated Hospital of Xiamen University, Xiamen 361003, China
| | - Hongming Liu
- Department of Thoracic Surgery, the First Affiliated Hospital of Xiamen University, Xiamen 361003, China
| | - Ning Li
- Department of Thoracic Surgery, the First Affiliated Hospital of Xiamen University, Xiamen 361003, China
| | - Suhuan Liu
- Department of Diabetes Research Institute, the First Affiliated Hospital of Xiamen University, Xiamen 361003, China
| | - Bing Hao
- Department of Nuclear Medicine, the First Affiliated Hospital of Xiamen University, Xiamen 361003, China
| | - Xiuyi Yu
- Department of Thoracic Surgery, the First Affiliated Hospital of Xiamen University, Xiamen 361003, China
| | - Jie Jiang
- Department of Thoracic Surgery, the First Affiliated Hospital of Xiamen University, Xiamen 361003, China
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Zhang L, Li M, Li Z, Kedeer X, Wang L, Fan Z, Chen C. Three-dimensional printing of navigational template in localization of pulmonary nodule: A pilot study. J Thorac Cardiovasc Surg 2017; 154:2113-2119.e7. [PMID: 29017792 DOI: 10.1016/j.jtcvs.2017.08.065] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 08/05/2017] [Accepted: 08/19/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Small pulmonary nodules are a common problem, especially with the wide implementation of lung cancer-screening program. This poses a great challenge to thoracic surgeons because of the difficulty of nodule localization. We recently built an efficient, customized navigational template using 3-dimensional (3D) printing technology to facilitate the procedure of lung nodule localization. This study aims to investigate its feasibility in clinical application. METHODS Patients with peripheral lung nodules (<2 cm) were enrolled. Preadmission computed tomography images were downloaded and reconstructed into a 3D model. A digital model of the navigational template was designed via computer-aided design software and then exported into 3D printer to produce physical template. The precision of the template-guided nodule localization and associated complications were evaluated. RESULTS A total of 16 patients were enrolled, and 18 nodules were localized through template-guided localization. The success rate of lung nodule localization was 100%, and the median time of localization was 13 minutes (range 10-16 minutes). In our series, no significant complication occurred, except for 2 asymptomatic pneumothoraxes. The median deviation between the localizer and the center of the nodule was 10.0 mm, ranging from 5 to 20 mm. CONCLUSIONS This novel navigational template created by 3D printing technology is feasible, and it has acceptable accuracy for the application in lung nodule localization. The use of this navigational template could facilitate the procedure of lung nodule localization and may potentially break the dependence of percutaneous localization on computed tomography scanning.
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Affiliation(s)
- Lei Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Mu Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Zeyao Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Xiermaimaiti Kedeer
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Long Wang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Ziwen Fan
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
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Wang L, Zhang X, Li M, Kadeer X, Dai C, Shi Z, Chen C. Remedial localization after dislodgement of primary mechanical localization in lung surgery. J Thorac Dis 2017; 9:1240-1246. [PMID: 28616274 DOI: 10.21037/jtd.2017.04.61] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Unhooking or displacement of hookwire or microcoil due to technical failures is rather common. We aim to establish a new technique for remedial localization in the case of displacement or unhooking of primary mechanical localization during lung surgery. METHODS From February 2014 to September 2015, 18 consecutive cases of intraoperative dislodgement during video-assisted thoracoscopic surgery (VATS) were enrolled. Nodule's projection on body surface was located by analyzing computed tomography (CT) images, and a needle was inserted into thoracic cavity through this point. The lung was then inflated, and a small burn was made where the needle tip touched the visceral plural. Wedge resections were subsequently performed for these impalpable small lesions. RESULTS Eighteen solitary pulmonary nodules (SPNs) from 18 patients were scheduled for VATS wedge resections in this series, including 6 (33.3%) hookwire localization and 12 (66.7%) microcoil localization. Fifteen (83.3%) of 18 nodules were pure ground glass opacity (pGGO) and 3 (16.7%) mixed ground glass opacity (mGGO). The mean diameter of SPNs was 7.7±3.6 mm. The mean distance from SPN to pleura was 12.2±10.9 mm. During remedial localization, 17 (94.4%) nodules were removed successfully by wedge resection, and segmentectomy was performed only in one case with failed outcome. Paraffin pathology showed 2 (11.1%) atypical adenomatous hyperplasia (AAH), 11 (61.1%) adenocarcinoma in situ (AIS), 4 (22.2%) minimally invasive adenocarcinoma (MIA), and 1 (5.6%) inflammatory disease. CONCLUSIONS This remedial localization technique is practical and reliable. It is a good backup plan in the case of dislodgement, and it can help prevent extended lung resection.
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Affiliation(s)
- Long Wang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Xufeng Zhang
- Department of Thoracic Surgery, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China
| | - Mu Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Xiermaimaiti Kadeer
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Chenyang Dai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Zhe Shi
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
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Zhong Y, Xu XQ, Pan XL, Zhang W, Xu H, Yuan M, Kong LY, Pu XH, Chen L, Yu TF. Retrospective Evaluation of Safety, Efficacy and Risk Factors for Pneumothorax in Simultaneous Localizations of Multiple Pulmonary Nodules Using Hook Wire System. Cardiovasc Intervent Radiol 2017; 40:1408-1414. [PMID: 28357573 DOI: 10.1007/s00270-017-1631-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 03/21/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of the hook wire system in the simultaneous localizations for multiple pulmonary nodules (PNs) before video-assisted thoracoscopic surgery (VATS), and to clarify the risk factors for pneumothorax associated with the localization procedure. METHODS Between January 2010 and February 2016, 67 patients (147 nodules, Group A) underwent simultaneous localizations for multiple PNs using a hook wire system. The demographic, localization procedure-related information and the occurrence rate of pneumothorax were assessed and compared with a control group (349 patients, 349 nodules, Group B). Multivariate logistic regression analyses were used to determine the risk factors for pneumothorax during the localization procedure. RESULTS All the 147 nodules were successfully localized. Four (2.7%) hook wires dislodged before VATS procedure, but all these four lesions were successfully resected according to the insertion route of hook wire. Pathological diagnoses were acquired for all 147 nodules. Compared with Group B, Group A demonstrated significantly longer procedure time (p < 0.001) and higher occurrence rate of pneumothorax (p = 0.019). Multivariate logistic regression analysis indicated that position change during localization procedure (OR 2.675, p = 0.021) and the nodules located in the ipsilateral lung (OR 9.404, p < 0.001) were independent risk factors for pneumothorax. CONCLUSION Simultaneous localizations for multiple PNs using a hook wire system before VATS procedure were safe and effective. Compared with localization for single PN, simultaneous localizations for multiple PNs were prone to the occurrence of pneumothorax. Position change during localization procedure and the nodules located in the ipsilateral lung were independent risk factors for pneumothorax.
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Affiliation(s)
- Yan Zhong
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, China
| | - Xiao-Quan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, China
| | - Xiang-Long Pan
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Zhang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, China
| | - Hai Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, China
| | - Mei Yuan
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, China
| | - Ling-Yan Kong
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, China
| | - Xue-Hui Pu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, China
| | - Liang Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Tong-Fu Yu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, China.
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