Percutaneous Computed Tomography-Guided Radiotracer-Assisted Localization of Difficult Pulmonary Nodules in Uniportal Video-Assisted Thoracic Surgery

Radio-Guided Lung Surgery: A Feasible Approach for a Cancer Precision Medicine

BACKGROUND

Radio-guided surgery is a reliable approach used for localizing ground-glass opacities, lung nodules, and metastatic lymph nodes. Lung nodules, lymph node metastatic involvement, and ground-glass opacities often represent a challenge for surgical management and clinical work-up.

METHODS

PubMed research was conducted from January 1997 to June 2023 using the keywords "radioguided surgery and lung cancer".

RESULTS

Different studies were conducted with different tracers: technetium-99m-albumin macroaggregates, cyanoacrylate combined to technetium-99m-sulfur colloid, indium-111-pentetreotide, and fluorine-18-deoxyglucose. A study proposed naphthalocyanine radio-labeled with copper-64. Radio-guided surgery has been demonstrated to be a reliable approach in localizing a lesion, and has a low radiological burden for personnel exposure and low morbidity. The lack of necessity to conduct radio-guided surgery under fluoroscopy or echography makes this radio-guided surgery an easy way of performing precise surgical procedures.

CONCLUSIONS

Radio-guided surgery is a feasible approach useful for the intraoperative localization of ground-glass opacities, lung nodules, and metastatic lymph nodes. It is a valid alternative to the existing approaches due to its low cost, associated low morbidity, the possibility to perform the procedure after several hours, the low radiation dose applied, and the small amount of time that is required to perform it.

Preoperative CT-guided Fiducial Marker Placement for Surgical Localization of Pulmonary Nodules

PURPOSE

To assess the technical success and complication rates of CT-guided fiducial marker placement for the localization of pulmonary nodules and to assess the surgical localization failure rate.

MATERIALS AND METHODS

This was a single-center, retrospective analysis of consecutive patients who underwent CT-guided fiducial marker placement procedures between 2014 and 2020. End points included the technical success of the fiducial marker placement, procedural complications, and the surgical localization failure rate. A two-sample t test and a Fisher exact test were used to compare continuous and categorical variables, respectively. Multivariate logistic regression was used to identify independent risk factors for complications.

RESULTS

A total of 198 preoperative CT-guided fiducial marker placement procedures were performed in 190 patients (mean age, 64 years ± 12 [standard deviation]; 121 women) to localize 205 nodules (mean size, 10 mm ± 4; mean distance to the pleura, 10 mm ± 9). The technical success rate was 98.5% (195 of 198). There were no major complications. A total of 202 nodules were resected during 193 procedures performed 5 days ± 13 after the fiducial marker placement (range, 0-123 days). Surgical localization failure occurred in one patient (0.5%). Of the resected nodules, 146 were lung cancers, 26 nodules were metastases, two were carcinoid tumors, and 28 were benign.

CONCLUSION

The CT-guided fiducial marker placement of pulmonary nodules was safe, effective, and resulted in a low surgical localization failure rate.Keywords: CT, Percutaneous, Thorax, Lung.

Lung nodule radio-guided localization and uniportal video-assisted thoracoscopic surgery resection

Since the introduction of lung nodule radio-guided localization, multiport video-assisted thoracoscopic surgery resection has been widely described. To date, only one series has reported the use of uniportal approach. Our objective is to describe the experience of a single institution of lung nodule radio-guided localization and uniportal video-assisted thoracoscopic surgery resection. Retrospective cohort study based on data from medical records of patients between May 2012 and April 2019. Twenty-four patients were included, 13 were women (54.2%) with a median age of 59.5 years (range 19 and 81 years). Median nodule size was 7 mm (range 3-12 mm) and 19 (79.2%) patients had single lung nodule. The main indication was sub-centimetric nodule in 22 (91.6%) patients followed by a deep localization in 10 (41.6%) patients and sub-solid nodule in 9 (37.5%) patients. Median surgical time was 102.5 min (range 55-160 min). 4 (16.6%) patients had malignant neoplasm of the lung, 10 (41.7%) patients had lung metastases and 10 (41.7%) patients had benign lung lesions. The success rate found was 95.8%. Concordance analysis between palpation of the pulmonary nodule and the presence of the nodule in the histopathology was rated as poor, kappa value - 0.71 (P = 0.186) and between the resection of the pulmonary nodule according to the presence of the nodule in the pathology report was rated as good, Kappa value 0.625 (P = 0.001). Lung nodule radio-guided localization and uniportal video-assisted thoracoscopic surgery resection has a similar success rate and complications to those described by multiport video-assisted thoracoscopic surgery resections.

Comparison of CT-guided localization using hook wire or coil before thoracoscopic surgery for ground glass nodules

OBJECTIVE

To compare two kinds of metal markers for preoperative localization of ground glass nodules (GGNs).

METHODS

We retrospectively investigated data from 198 cases of GGN localization and compared the success rate and complications of both approaches.

RESULTS

In the hook wire and coil groups, the success rates of CT-guided localization for GGNs were 99.2 and 98.7%, respectively (p = 1.000). The success rates of video-assisted thoracoscopic surgery in both groups were 100% without transthoracic surgery. The post-localization complication rates in the hook wire group and coil group were 36.9 and 32.9% (p = 0.568), and the postoperative complication rates in the hook wire and coil groups were 13.9 and 11.8%, respectively (p = 0.672).

CONCLUSIONS

Preoperative localization of GGNs with both hook wire and coil methods proved to be useful and effective. Both methods have acceptable preoperative and postoperative complication rates, but the localization and operation times were shorter for the hook wire group than the coil group.

ADVANCES IN KNOWLEDGE

Most of previous articles studied a single preoperative localization method. Few studies have compared the preoperative and postoperative methods for metal markers. This paper compared two preoperative localization methods for GGNs to provide clinical guidance.