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Liu Q, Guo X, Wang Z, Xu H, Huang W, Liu J, Wang Z, Yan F, Wu Z, Ding X. Computed Tomography-guided Percutaneous Lung Biopsy With Electromagnetic Navigation Compared With Conventional Approaches: An Open-label, Randomized Controlled Trial. J Thorac Imaging 2024; 39:247-254. [PMID: 37982518 DOI: 10.1097/rti.0000000000000763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
PURPOSE The purpose of this study was to assess the efficiency and safety of computed tomography (CT)-guided percutaneous biopsy of lung lesions with electromagnetic (EM) navigation and compare them with those of conventional approaches. MATERIALS AND METHODS Seventy-nine patients with lung or liver lesions who needed biopsies were enrolled in this trial. All patients were randomly assigned to the E group underwent CT-guided percutaneous biopsies with the EM navigation system or to the C group treated with conventional approaches. RESULTS In total, 27 patients with lung lesions were assigned to the E group, and 20 patients were assigned to the C group. The diagnostic success rate was 92.6% and 95% in both groups, respectively ( P >0.9999). The median number of needle repositions in the E group was less than that in the C group (2.0 vs. 2.5, P =0.03). The positioning success rate with 1 or 2 needle repositions for the E group was significantly higher than the C group (81.5% vs. 50%, P =0.03). The median accuracy of the puncture location in the E group was better than that in the C group (2.0 vs. 6.6 mm, P <0.0001). The total procedure time lengthened in the E group compared with the C group (30.5±1.6 vs. 18.3±1.7 min, P <0.0001), but the number of CT acquisitions was not significantly different ( P =0.08). There was no significant difference in complication incidence between the 2 groups ( P =0.44). CONCLUSION The EM navigation system is an effective and safe auxiliary tool for CT-guided percutaneous lung biopsy, but lengthen the procedure time. TRIAL REGISTRATION ChiCTR2100043361, registered February 9, 2021-retrospectively registered ( http://www.medresman.org.cn/uc/project/projectedit.aspx?proj=7591 ).
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Affiliation(s)
- Qin Liu
- Departments of Interventional Radiology
| | | | | | - Hao Xu
- Departments of Interventional Radiology
- Department of Vascular Surgery and Interventional Radiology, Suzhou DuShu Lake Hospital, Soochow University, Suzhou, China
| | - Wei Huang
- Departments of Interventional Radiology
| | | | | | - Fuhua Yan
- Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
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Chia AQX, Gogna A, Pena AMT, Sai VVS, Chandramohan S, Chan SJMX, Ong BH. Hybrid operating room with ceiling mounted imaging system assisted pre-operative and intra-operative lung nodule localization for thoracoscopic resections: a 5-year case series. J Cardiothorac Surg 2024; 19:85. [PMID: 38341594 PMCID: PMC10858515 DOI: 10.1186/s13019-024-02564-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Video-assisted thoracoscopic (VATS) lung resections are increasingly popular and localization techniques are necessary to aid resection. We describe our experience with hybrid operating room (OR) cone-beam computed tomography (CT) assisted pre-operative and intra-operative lesion localization of lung nodules for VATS wedge resections, including our novel workflow using the hybrid OR cone-beam CT to re-evaluate patients who have undergone pre-operative localization for those who are unsuitable for intra-operative localization. METHODS Retrospective analysis of all consecutive patients with small (≤ 20 mm), deep (≥ 10 mm distance from pleura) and/or predominantly ground-glass nodules selected for lesion localization in the Interventional Radiology suite followed by re-evaluation with cone-beam CT in the hybrid OR (pre-operative), or in the hybrid OR alone (intra-operative), prior to intentional VATS wedge performed by a single surgeon at our centre from January 2017 to December 2021. RESULTS 30 patients with 36 nodules underwent localization. All nodules were successfully resected with a VATS wedge resection, although 10% of localizations had hookwire or coil dislodgement. The median effective radiation dose in the pre-operative group was 10.4 mSV including a median additional radiation exposure of 0.9 mSV in the hybrid OR for reconfirmation of hookwire or coil position prior to surgery (p = 0.87). The median effective radiation dose in the intra-operative group was 3.2 mSV with a higher mean rank than the intra-operative group, suggesting a higher radiation dose (p = 0.01). CONCLUSIONS We demonstrate that our multidisciplinary approach utilizing the hybrid OR is safe and effective. Intra-operative localization is associated with lower radiation doses. Routine use of cone-beam CT to confirm the position of the physical marker prior to surgery in the hybrid OR helps mitigate consequences of localization failure with only a modest increase in radiation exposure.
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Affiliation(s)
- Audrey Qi Xin Chia
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore, Singapore
| | - Apoorva Gogna
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore, Singapore
| | | | - Vishnu Vemula Sri Sai
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Sivanathan Chandramohan
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore, Singapore
| | - Shaun Ju Min Xavier Chan
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore, Singapore
| | - Boon-Hean Ong
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.
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Wang L, Ge L, Song S, Ren Y. Clinical applications of minimally invasive uniportal video-assisted thoracic surgery. J Cancer Res Clin Oncol 2023; 149:10235-10239. [PMID: 37269347 DOI: 10.1007/s00432-023-04920-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/23/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND In recent years, the field of minimally invasive thoracic surgery has experienced significant advancements driven by improvements in video-assisted thoracoscopic surgery (VATS) techniques and surgical instruments. These advances have given rise to uniportal VATS as a new area of exploration in minimally invasive thoracic surgery. This technique presents several potential advantages, including reduced access trauma, less postoperative pain, improved cosmesis, fewer complications, shorter hospital stays, and faster rehabilitation, ultimately leading to an improvement in patient quality of life. PURPOSE This article reviews the evolutionary history of minimally invasive thoracic surgery, highlights novel techniques, explores possible applications and obtained results, and discusses future prospects of uniportal VATS. CONCLUSION Experienced thoracic surgeons have demonstrated the capacity to perform uniportal VATS with a high level of safety and efficacy. Further studies are necessary to assess its long-term efficacy, address limitations, and enhance clinical decision-making for optimal treatment of thoracic conditions.
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Affiliation(s)
- Linlin Wang
- Department of Thoracic Surgery, Shenyang Chest Hospital & Tenth People's Hospital, No. 11, Beihai Street, Dadong District, Shenyang, 110044, Liaoning, People's Republic of China
| | - Lihui Ge
- Department of Health Management, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, HePing District, Shenyang, 110004, Liaoning, People's Republic of China
| | - Shiyuan Song
- Department of Thoracic Surgery, Shenyang Chest Hospital & Tenth People's Hospital, No. 11, Beihai Street, Dadong District, Shenyang, 110044, Liaoning, People's Republic of China
| | - Yi Ren
- Department of Thoracic Surgery, Shenyang Chest Hospital & Tenth People's Hospital, No. 11, Beihai Street, Dadong District, Shenyang, 110044, Liaoning, People's Republic of China.
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Yutaka Y, Sato T, Hidaka Y, Kato T, Kayawake H, Tanaka S, Yamada Y, Ohsumi A, Nakajima D, Hamaji M, Menju T, Date H. Electromagnetic navigation bronchoscopy-guided radiofrequency identification marking in wedge resection for fluoroscopically invisible small lung lesions. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY : OFFICIAL JOURNAL OF THE EUROPEAN ASSOCIATION FOR CARDIO-THORACIC SURGERY 2022; 63:6972779. [PMID: 36617166 DOI: 10.1093/ejcts/ezad006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/14/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023]
Abstract
OBJECTIVES We developed a novel wireless localization technique after electromagnetic navigation bronchoscopy-guided radiofrequency identification marker placement for fluoroscopically invisible small lung lesions. We conducted an observational study to investigate the feasibility of this technique and retrospectively compared 2 marking approaches with or without cone-beam computed tomography (CBCT). METHODS Consecutive patients from January 2021 to March 2022 in our institution were enrolled. Markers were placed central to the lesions either in a bronchoscopic suite under intravenous anaesthesia or a hybrid operation theatre with CBCT under general anaesthesia. The efficacy of the 2 marking methods was compared using an inverse probability of treatment weighting adjusted analysis. RESULTS Totally 80 markers were placed (45 under CBCT and 35 under fluoroscopy) for 74 patients with 80 lesions [mean size: 6.9 mm (interquartile range: 5.1-8.4) at a median depth from the pleura of 14.0 mm (interquartile range: 8.5-19.5)]. The median distance from marker to lesion was 9.1 mm, with a pleural depth of 15.5 mm. The tumour resection rate was 97.5% (78/80) with the median surgical margin of 10.0 mm (interquartile range: 8.0-11.0). Although the bronchoscopy time was longer using CBCT because of the need for 2.8 scans per lesion, the distance from the marker to the lesion was shorter for marking using CBCT than marking using fluoroscopy (adjusted difference: -4.56, 95% confidence interval: -6.51 to -2.61, P < 0.001). CONCLUSIONS Electromagnetic navigation bronchoscopy-guided radiofrequency identification marking provided a high tumour resection rate with sufficient surgical margins.
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Affiliation(s)
- Yojiro Yutaka
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Toshihiko Sato
- Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University Hospital, Fukuoka, Japan
| | - Yu Hidaka
- Department of Biomedical Statistics and Bioinformatics, Kyoto University, Kyoto, Japan
| | - Takao Kato
- Department of Clinical Research Facilitation, Institute for Advancement of Clinical and Translational Science, Kyoto University, Kyoto, Japan
| | - Hidenao Kayawake
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Satona Tanaka
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Yoshito Yamada
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Akihiro Ohsumi
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Daisuke Nakajima
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Masatsugu Hamaji
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Toshi Menju
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
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Bello I, Obeso A, Navales I. Afinando el diagnóstico, minimizando el abordaje: la evolución del marcaje de nódulos pulmonares. Arch Bronconeumol 2022; 58:392-394. [DOI: 10.1016/j.arbres.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/14/2022] [Accepted: 02/27/2022] [Indexed: 11/25/2022]
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Hsu PK, Lee YY, Chuang LC, Ting CK, Tsou MY. Nonintubated versus intubated “one-stage” preoperative localization and thoracoscopic lung resection. JTCVS Tech 2021; 10:517-525. [PMID: 34977800 PMCID: PMC8691827 DOI: 10.1016/j.xjtc.2021.09.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/14/2021] [Indexed: 01/05/2023] Open
Abstract
Objective Nonintubated anesthesia, electromagnetic navigation (EMN)-guided preoperative localization, and uniportal video-assisted thoracic surgery (VATS) are recent innovations in minimally invasive thoracic surgery. This study aimed to explore the feasibility of applying nonintubated anesthesia in a “one-stage” localization and resection workflow. Methods Patients who underwent EMN-guided preoperative percutaneous localization with indocyanine green (ICG) and uniportal VATS were included. Perioperative data were compared between patients receiving nonintubated anesthesia and those receiving general anesthesia with endotracheal intubation. Results Forty-six patients with a total of 50 nodules were included in the study. Overall, finger palpation could be avoided in 94% of the nodules, whereas fluorescent green signals with a clear border on the pleural surface were noted in 91.3% (21 of 23) of nodules in the nonintubated group and 88.9% (24 of 27) of nodules in the intubated group. Intraoperatively, the nonintubated group had a lower median pH (7.33 [interquartile range (IQR), 7.28-7.40] vs 7.41 [IQR, 7.38-7.44]; P = .003), higher median arterial CO2 (45.5 [IQR, 41.1-58.7] mm Hg vs 38.4 [IQR, 35.3-40.6] mm Hg; P < .001), and lower arterial oxygen (322 [IQR, 211-433] mm Hg vs 426 [IQR, 355-471] mm Hg; P = .005) levels compared with the intubated group. The nonintubated group also had a shorter median registration time (2.0 [IQR, 1.0-3.0] minutes vs 3.0 [IQR, 2.0-8.0] minutes; P = .008) and total time in the operating room (150 [IQR, 130-175] minutes vs 170 [IQR, 135-203] minutes; P = .035), whereas no between-group differences were seen in localization and operative time. The duration of chest drainage, postoperative complications, pathologic diagnosis, and margins were similar in the 2 groups. Conclusions Nonintubated “one-stage” EMN-guided percutaneous ICG localization and uniportal VATS can be an option for selected patients undergoing treatment for small peripheral nodules.
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Affiliation(s)
- Po-Kuei Hsu
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Address for reprints: Po-Kuei Hsu, MD, PhD, Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd, Taipei, Taiwan.
| | - Yi-Ying Lee
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Lin-Chi Chuang
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chien-Kun Ting
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mei-Yung Tsou
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
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[Expert Consensus on Technical Specifications of Domestic Electromagnetic Navigation Bronchoscopy System in Diagnosis, Localization and Treatment (2021 Edition)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2021; 24:529-537. [PMID: 34412766 PMCID: PMC8387647 DOI: 10.3779/j.issn.1009-3419.2021.101.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Electromagnetic navigation bronchoscopy (ENB) is a novel type of bronchoscopy based on electromagnetic positioning technique combined with virtual bronchoscopy, three-dimensional computed tomography (CT) imaging and respiratory gating technique, which has been widely applied in clinic practice. In recent years, the domestic electromagnetic navigation system has also been developed rapidly, and its effectiveness and safety in the diagnosis, localization, and treatment of peripheral pulmonary lesions have been initially verified. In order to optimize and standardize the technical specifications of domestic ENB and guide its application in clinical practice, the consensus statement has been organized and written in a collaborative effort by the Professional Committee on Respiratory Equipment Technology of Chinese Medical Equipment Association and the Expert Group on Technical of Domestic Electromagnetic Navigation Bronchoscopy.
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Luo YH, Chiu CH, Scott Kuo CH, Chou TY, Yeh YC, Hsu HS, Yen SH, Wu YH, Yang JCH, Liao BC, Hsia TC, Chen YM. Lung Cancer in Republic of China. J Thorac Oncol 2021; 16:519-527. [PMID: 33781442 DOI: 10.1016/j.jtho.2020.10.155] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 01/21/2023]
Affiliation(s)
- Yung-Hung Luo
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Republic of China; School of Medicine, National Yang-Ming University, Taipei, Republic of China; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Republic of China
| | - Chao-Hua Chiu
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Republic of China; School of Medicine, National Yang-Ming University, Taipei, Republic of China
| | - Chih-Hsi Scott Kuo
- Thoracic Oncology Unit, Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan City, Republic of China; College of Medicine, Chang Gung University, Taoyuan City, Republic of China
| | - Teh-Ying Chou
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Republic of China; Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Republic of China
| | - Yi-Chen Yeh
- School of Medicine, National Yang-Ming University, Taipei, Republic of China; Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Republic of China; Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Republic of China
| | - Han-Shui Hsu
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Republic of China; Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Republic of China
| | - Sang-Hue Yen
- Department of Radiation Oncology, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei, Republic of China
| | - Yuan-Hung Wu
- School of Medicine, National Yang-Ming University, Taipei, Republic of China; Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Republic of China
| | - James Chih-Hsin Yang
- Department of Oncology, National Taiwan University Cancer Center, Taipei, Republic of China
| | - Bin-Chi Liao
- Department of Oncology, National Taiwan University Cancer Center, Taipei, Republic of China
| | - Te-Chun Hsia
- College of Health Care, China Medical University, Taichung, Republic of China; Department of Internal Medicine, China Medical University Hospital, Taichung, Republic of China
| | - Yuh-Min Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Republic of China; School of Medicine, National Yang-Ming University, Taipei, Republic of China.
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Chen J, Pan X, Gu C, Zheng X, Yuan H, Yang J, Sun J. The feasibility of navigation bronchoscopy-guided pulmonary microcoil localization of small pulmonary nodules prior to thoracoscopic surgery. Transl Lung Cancer Res 2020; 9:2380-2390. [PMID: 33489800 PMCID: PMC7815366 DOI: 10.21037/tlcr-20-1206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background Accurate preoperative localization of small pulmonary nodules facilitates the rapid and precise video-assisted thoracoscopic surgery (VATS). This study aims to evaluate the feasibility, safety, and efficacy of navigation bronchoscopy-guided pulmonary microcoil placement for preoperative pulmonary nodule localization. Methods Twelve lung lesions were simulated by mixing lipiodol in three porcine models. After 1 week, two microcoils per lesion were deployed under bronchoscopic guidance. Computed tomography scans were then performed 1 day, 1 week, 2 weeks, and 4 weeks after the deployment to assess the position of the microcoils relative to the lesions. Surgical resection of the simulated lesions was performed under fluoroscopy 5 weeks after the deployment and the accuracy, stability, and associated complications of the microcoil localization were evaluated. Following this, an exploratory clinical study was conducted on three patients with pure ground-glass pulmonary nodules. Results The mean diameter of the twelve simulated lung lesions was 9.55±2.36 mm, and the mean distance from the pleura to the lesions was 8.29±2.99 mm. Twenty-four pulmonary microcoils were implanted in the bronchi surrounding the lesions. Four weeks later, the mean distance between the microcoils and the center of the lesions was 16.12±8.97 mm and the average migration of the microcoils relative to the baseline position (1 day after implantation) was 3.48±4.56 mm. All microcoils and target lesions were successfully resected in both the animal experiment and clinical study and no complications, such as pneumothorax, were observed during marker implantation or postoperative follow-up. Conclusions The preoperative localization of pulmonary nodules by navigation bronchoscopy-guided microcoil placement is a safe, stable, and effective technique with minimal complication risk. This procedure can assist subsequent thoracoscopic resection.
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Affiliation(s)
- Junxiang Chen
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Xufeng Pan
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Chuanjia Gu
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Xiaoxuan Zheng
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Haibin Yuan
- Department of Emergency, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jun Yang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jiayuan Sun
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
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Abstract
Lung cancer is the most common cause of cancer death in the world. However, recent studies have found that patients with pulmonary ground-glass opacity (GGO) have a better prognosis. Considering its low invasiveness, sublobar resection may be an appropriate treatment of choice. Low-dose computed tomography (CT) is recommended for the high-risk groups of lung cancer. Patients with nonsolid nodule are suggested to take annual low dose CT following-up. For part-solid or solid nodules, the solid component size less or more than 8 mm is the watershed of surgical treatment. Increasing tumor size is a hint of malignancy. Biopsy can be performed for clinically highly suspected malignant nodules. The endobronchial ultrasound biopsy, CT-guide biopsy, or surgical excision are the mainstream for the diagnosis of lung nodules. But for treatment, the sublobar resection is the mainstream of pulmonary GGO. A precise localization technique makes surgeons get enough resection margin and preserve more pulmonary function of the patients. The different localization technique is suitable for different kind nodular position. For patients with pure pulmonary GGO, annual low dose CT checkup is suitable. If the tumor size or solid part of the tumors increased gradually, adequate sublobar resection after tumor localization technique may provide good prognosis and preserve more pulmonary function of the patients.
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Affiliation(s)
- Yi-Han Lin
- Division of Thoracic Surgery, Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan, ROC
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Han-Shui Hsu
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Address correspondence. Dr. Han-Shui Hsu, Department of Surgery, Division of Thoracic Surgery, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, ROC. E-mail address: (H.-S. Hsu)
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