1
|
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.
Collapse
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.
| |
Collapse
|
2
|
Gilberto GM, Falsarella PM, Andrade JRD, Schmid BP, Mariotti GC, Terra RM, Campos JRMD, Succi JE, Garcia RG. Lung nodule localization in hybrid room before minimally invasive thoracic surgery: series of 20 cases and literature review. EINSTEIN-SAO PAULO 2022; 20:eAO6665. [PMID: 35476085 PMCID: PMC9000983 DOI: 10.31744/einstein_journal/2022ao6665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/12/2021] [Indexed: 11/22/2022] Open
Abstract
Objective To describe an experience in the preoperative localization of small pulmonary nodules and ground-glass lesions to guide minimally invasive thoracic surgery; in addition, a literature review was conducted, including the main advantages and disadvantages of the different agents used, and site marking in a hybrid operating room. Methods A retrospective search was conducted in a Interventional Radiology Department database, between March 2015 and May 2019, to identify patients undergoing preoperative percutaneous marking of lung injuries measuring up to 25mm. Results A total of 20 patients were included and submitted to descriptive analysis. All patients were marked in a hybrid room, at the same surgical-anesthetic time. Most often used markers were guidewire, Lipiodol® and microcoils. Despite one case of coil displacement, two cases of pneumothorax, and one case of hypotension after marking, all lesions were identified and resected accordingly from all patients. Conclusion Preoperative percutaneous localization of lung injuries in hybrid room is an effective and a safe technique, which can have decisive impact on surgical resection. The choice of marker and of the operating room scenario should be based on availability and experience of service. Multidisciplinary discussions with surgical teams, pathologists, and interventional radiologists are crucial to improve outcome of patients.
Collapse
|
3
|
Yao F, Su YC, Chao JP, Chen CK, Lee HH, Ya HH. Image-guided video-assisted thoracoscopic localization and resection for multiple ipsilateral pulmonary nodules. FORMOSAN JOURNAL OF SURGERY 2022. [DOI: 10.4103/fjs.fjs_112_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
4
|
Kong J, Guo J, Zhang H, Li Y, Wang G, Zhang Y. CT-guided localization techniques of small pulmonary nodules: a prospective non-randomized controlled study on pulmonary nodule localization needle and methylene blue staining with surgical glue. J Thorac Dis 2020; 12:6826-6835. [PMID: 33282384 PMCID: PMC7711370 DOI: 10.21037/jtd-20-3147] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Thoracoscopic resection of small pulmonary nodules (SPNs) is challenging. Accurate preoperative computed tomography-guided localization of SPNs is key to successful rection. The aim of the present study was to evaluate the clinical value of a novel localization needle and methylene blue staining combined with surgical glue (MBSG) and to explore the risk factors for post-localization complications. Methods This prospective, non-randomized controlled study was conducted on 110 patients who received either MBSG or novel needle localization prior to video-assisted thoracoscopic surgery (VATS) from January 2019 to December 2019 at Shenzhen People’s Hospital. The primary endpoints were the safety and the success rates of the 2 localization techniques. The secondary endpoints were operative time and feasibility. Results The 110 patients were categorized into 2 groups: the MBSG group (n=84) and the pulmonary nodule localization needle group (n=26). The success rate of pre-VATS localization was 100% in both groups. No deaths or serious complications occurred during localization. The rates of pneumothorax, pulmonary hemorrhage, and localization-induced cough were 38.1%, 25%, and 7.14%, respectively, in the MBSG group, and 26.92%, 19.23%, and 0%, respectively, in the pulmonary nodule localization needle group. Differences between the 2 groups were not statistically significant (P>0.05). Total complication rate and the incidence of pain were significantly lower in the pulmonary nodule localization needle group (χ2=4.441 and 4.295, respectively; P<0.05). The difference in operative time between the 2 groups was not statistically significant (P>0.05). Dye diffusion occurred in 2 patients in the MBSG group; however, it had no impact on VATS or on the pathological analysis. Neither displacement nor dislocation was observed in the pulmonary nodule localization needle group. Logistic regression analysis showed that the localization technique was an independent risk factor for total complications (odds ratio: 2.634, 95% confidence interval: 1.022–6.789, P<0.05). Conclusions Both techniques can localize SPNs effectively prior to VATS. The pulmonary nodule localization needle technique has a lower incidence of complications.
Collapse
Affiliation(s)
- Jian Kong
- Department of Interventional Radiology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Jianxi Guo
- Department of Interventional Radiology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Hua Zhang
- Department of Interventional Radiology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Yong Li
- Department of Interventional Radiology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Guangsuo Wang
- Department of Thoracic Surgery, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Yanfang Zhang
- Department of Interventional Radiology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| |
Collapse
|
5
|
Azari F, Kennedy G, Singhal S. Intraoperative Detection and Assessment of Lung Nodules. Surg Oncol Clin N Am 2020; 29:525-541. [PMID: 32883456 DOI: 10.1016/j.soc.2020.06.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Lung cancer is the most frequent cause of cancer-related death worldwide. Despite advances in systemic therapy, the 5-year survival remains humbling at 4% to 17%. For those diagnosed early, surgical therapy can yield potentially curative results. Surgical resection remains a cornerstone of medical care. Success hinges on sound oncologic resection principles. Various techniques can be used to identify pulmonary nodules. A challenge is intraoperative assessment of the surgical specimen to confirm disease localization and ensure an R0 resection. The primary tool is frozen section. Understanding the options available enhances the arsenal of thoracic surgeons and leads to better patient care.
Collapse
Affiliation(s)
- Feredun Azari
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 6 White Building, Philadelphia, PA 19104, USA.
| | - Greg Kennedy
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 6 White Building, Philadelphia, PA 19104, USA
| | - Sunil Singhal
- Department of Surgery, Division of Thoracic Surgery, University of Pennsylvania, Perelman School of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, 6 White Building, Philadelphia, PA 19104, USA
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Imperatori A, Fontana F, Dominioni L, Piacentino F, Macchi E, Castiglioni M, Desio M, Cattoni M, Nardecchia E, Rotolo N. Video-assisted thoracoscopic resection of lung nodules localized with a hydrogel plug. Interact Cardiovasc Thorac Surg 2019; 29:137-143. [PMID: 30793736 DOI: 10.1093/icvts/ivz030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/03/2018] [Accepted: 01/08/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Computed tomography (CT)-guided hydrogel plug deployment was recently proposed for lung nodule preoperative localization and simultaneous prevention of pneumothorax. We analysed our initial experience with CT-guided hydrogel plug localization of lung nodules in patients undergoing video-assisted thoracoscopic (VATS) resection. METHODS We retrospectively evaluated the medical notes from 27 consecutive patients (mean age 68 ± 11 SD years; men 74%) undergoing VATS lung wedge resection for biopsy or definitive treatment of 28 small pulmonary nodules (malignant 82%) at a single institution between October 2017 and July 2018. Difficult intraoperative nodule localization was anticipated with a lesion <10 mm, a depth from pleura:size ratio >1, ground-glass opacity or the judgement of the operating surgeon. All lesions were preoperatively marked by deployment of a CT-guided hydrogel plug. Study end points were frequency of postlocalization pneumothorax; feasibility of delayed surgery; rate of localization of intraoperative nodule and rate of successful VATS resection. RESULTS The mean sizes of the solid nodules (n = 24) and of the ground-glass opacities (n = 4) were, respectively, 10.4 ± 3.4 mm and 16.0 ± 6.2 mm. One (4%) hydrogel plug marking procedure caused a clinically relevant pneumothorax. Nodule resection was scheduled flexibly as required by patient management/operating room scheduling: same day (11 nodules) or delayed [median 6 days (range 1-60 days)]; (17 nodules). All nodules were localized intraoperatively: 25 (89%) by hydrogel plug; 3 (11%) by palpation and pleural puncture hole visible after plug displacement. All nodules were completely excised by VATS, without complications. CONCLUSIONS CT-guided hydrogel plug marking was valuable for VATS localization and resection of challenging lung nodules. The plug minimized clinically relevant pneumothoraxes and allowed flexible surgical schedules.
Collapse
Affiliation(s)
- Andrea Imperatori
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Federico Fontana
- Interventional Radiology, Department of Radiology, University of Insubria, Varese, Italy
| | - Lorenzo Dominioni
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Filippo Piacentino
- Interventional Radiology, Department of Radiology, University of Insubria, Varese, Italy
| | - Edoardo Macchi
- Interventional Radiology, Department of Radiology, University of Insubria, Varese, Italy
| | - Massimo Castiglioni
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Matteo Desio
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Maria Cattoni
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Elisa Nardecchia
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Nicola Rotolo
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| |
Collapse
|
8
|
Hsieh MJ, Fang HY, Lin CC, Wen CT, Chen HW, Chao YK. Single-stage localization and removal of small lung nodules through image-guided video-assisted thoracoscopic surgery. Eur J Cardiothorac Surg 2019; 53:353-358. [PMID: 28958053 DOI: 10.1093/ejcts/ezx309] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/19/2017] [Accepted: 07/30/2017] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES This case series illustrates the feasibility of single-stage image-guided video-assisted thoracoscopic surgery for simultaneous localization and removal of small solitary pulmonary nodules (SPNs). The procedure was performed in a hybrid operating room using C-arm cone-beam computed tomography equipped with a laser-guided navigation system. METHODS Between October 2016 and January 2017, 12 consecutive patients presenting with SPNs underwent image-guided video-assisted thoracoscopic surgery. The feasibility and safety of the procedure were assessed through a retrospective review of the patients' clinical charts. RESULTS The median size of SPNs was 5.5 mm [interquartile range (IQR) 4-6 mm], whereas their median distance from the pleural surface was 11.7 mm (IQR 6-11.3 mm). All of the lesions were visible on intraoperative C-arm cone-beam computed tomography images, and localization was successful in 10 patients; thereafter, complete thoracoscopic resection was successfully performed. The median time required for the localization of SPNs was 45.5 min (IQR 36-60 min), whereas the median radiation exposure (expressed through the skin absorbed dose) was 223.2 mGy (IQR 180.3-321.3 mGy). Lesion localization was unsuccessful in 2 cases because to the development of pneumothorax induced by needle puncture. In such cases, a utility thoracotomy was required for the identification of SPNs. There was no operative mortality, and the median length of postoperative stay was 4 days (IQR 3.8-4 days). CONCLUSIONS The results of our case series support the feasibility of image-guided video-assisted thoracoscopic surgery for detection and removal of SPNs. Future efforts should be tailored to decrease localization time and minimize radiation exposure.
Collapse
Affiliation(s)
- Ming-Ju Hsieh
- Division of Thoracic Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsin-Yueh Fang
- Division of Thoracic Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Cheng Lin
- Department of Advanced Therapy, Siemens Healthineers, Taipei, Taiwan
| | - Chih-Tsung Wen
- Division of Thoracic Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Huan-Wu Chen
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yin-Kai Chao
- Division of Thoracic Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
9
|
Abstract
OBJECTIVE. The purpose of this study was to review preoperative CT-guided seed localization in the breast and axilla performed at my institution for lesions not visualized on routine mammography and ultrasound after neoadjuvant chemotherapy. CONCLUSION. Ten lesions (seven in the axilla, two in the breast, and one in the supraclavicular region) were localized with a radioactive seed under CT guidance. All were successfully excised at surgery, suggesting that CT guidance can be used when needle localization is not feasible using mammography or sonography.
Collapse
|
10
|
Park CH, Lee SM, Lee JW, Hwang SH, Kwon W, Han K, Hur J. Hook-wire localization versus lipiodol localization for patients with pulmonary lesions having ground-glass opacity. J Thorac Cardiovasc Surg 2019; 159:1571-1579.e2. [PMID: 31735392 DOI: 10.1016/j.jtcvs.2019.08.100] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 08/11/2019] [Accepted: 08/20/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Accurate and safe preoperative localization is useful for video-assisted thoracic surgery of small pulmonary lesions with ground-glass opacity (GGO). However, the optimal localization method is unclear. The aim of this study was to compare the usefulness and safety of the lipiodol and hook-wire localization techniques for video-assisted thoracic surgery of GGO lesions. METHODS This prospective, non-randomized comparative study was conducted between April 2014 and December 2016 at 8 qualifying university teaching hospitals. Two-hundred-fifty patients with pulmonary lesions having GGO were included. Patients were assigned in a 1:1 ratio to either the lipiodol (n = 125, 4 hospitals) or hook-wire group (n = 125, 4 hospitals) for preoperative localization procedures. Participants underwent preoperative localization via the lipiodol or hook-wire technique followed by thoracoscopic surgery. The primary endpoint was the procedure success rate. RESULTS The procedure success rates (hook-wire vs lipiodol group) were 94.40% versus 99.16% (P = .08). Localization-related complications occurred in 53.60% versus 48.33% of patients (P = .49). Hemorrhage rates were significantly greater in the hook-wire group than in the lipiodol group (21.6% vs 5.83%, P < .001). The lipiodol procedure time was significantly longer than that of the hook-wire technique (20.69 ± 9.34 vs 17.15 ± 7.91 minutes, P = .001). The initially positive surgical resection margin was significantly greater in the hook-wire group than in the lipiodol group (10.89% vs 2.38%, P = .02). CONCLUSIONS There was no significant difference in success rate between the hook-wire and lipiodol methods. However, the hemorrhage rate was significantly greater in the hook-wire group, whereas the hook-wire group showed greater initially positive surgical resection margins.
Collapse
Affiliation(s)
- Chul Hwan Park
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Min Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji Won Lee
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Republic of Korea
| | - Sung Ho Hwang
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Woocheol Kwon
- Department of Radiology, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Kyunghwa Han
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Hur
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | | |
Collapse
|
11
|
Tibana TK, de Carvalho TR, Arão Filho A, Marchiori E, Nunes TF. Pulmonary nodule localization guided by computed tomography using a nitinol guidewire before video-assisted thoracoscopic surgery. Radiol Bras 2019; 52:242-244. [PMID: 31435085 PMCID: PMC6696754 DOI: 10.1590/0100-3984.2018.0040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Tiago Kojun Tibana
- Hospital Universitário Maria Aparecida Pedrossian da Universidade Federal de Mato Grosso do Sul (HUMAP-UFMS), Campo Grande, MS, Brazil
| | - Tony Rocha de Carvalho
- Hospital Universitário Maria Aparecida Pedrossian da Universidade Federal de Mato Grosso do Sul (HUMAP-UFMS), Campo Grande, MS, Brazil
| | | | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Thiago Franchi Nunes
- Hospital Universitário Maria Aparecida Pedrossian da Universidade Federal de Mato Grosso do Sul (HUMAP-UFMS), Campo Grande, MS, Brazil
| |
Collapse
|
12
|
刘 宝. [Diagnosis and Treatment of Pulmonary Ground-glass Nodules]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:449-456. [PMID: 31315784 PMCID: PMC6712268 DOI: 10.3779/j.issn.1009-3419.2019.07.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 03/06/2019] [Accepted: 03/10/2019] [Indexed: 12/19/2022]
Abstract
Recent widespread use of high resolution computed tomography (HRCT) for the screening of lung cancer have led to an increase in the detection rate of very faint and smaller lesions known as ground-glass nodule (GGN). However, it had been proved that GGN was well associated with lung cancer in previous studies. Therefore, the classification, imaging characteristics, pathological type, follow-up, suggested managements and other clinical concerns of GGN were reviewed in this paper.
.
Collapse
Affiliation(s)
- 宝东 刘
- />100053 北京,首都医科大学宣武医院胸外科Department of Toracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| |
Collapse
|
13
|
Ko KH, Huang TW, Lee SC, Chang WC, Gao HW, Hsu HH. A simple and efficient method to perform preoperative pulmonary nodule localization: CT-guided patent blue dye injection. Clin Imaging 2019; 58:74-79. [PMID: 31279987 DOI: 10.1016/j.clinimag.2019.06.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/30/2019] [Accepted: 06/26/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the efficacy of computed tomography (CT)-guided localization with the injection of a low dose of patent blue dye (PBD) for the thoracoscopic resection of pulmonary nodules. MATERIALS AND METHODS Overall, 125 consecutive patients underwent CT-guided localization with injection of a lower dose of PBD between June 2015 and June 2016. The total injection dose relative to the distance between nodules and the visceral pleura was recorded. The clinical and radiological characteristics, technical details, pathological results and procedure-related complications were reviewed. RESULTS A total of 137 indeterminate pulmonary nodules were identified. The mean nodule size was 9.5 (3.0-22.0) mm. The mean injection dose of PBD relative to the distance between nodules and the visceral pleura was classified as follows: 0.07 ml: <1 cm, 0.1 ml: 1-2 cm and 0.18 ml: >2 cm. The mean time of CT-guided localization was 16.5 (10-50) min. The mean time interval from localization to surgery was 188 (24-1440) min. Pneumothorax developed in 50 patients (40%), and focal parenchymal hemorrhage occurred in 16 patients (12.8%) after localization. No patient required chest tube placement or emergent resuscitation. The success rate of dye marking was 98.5% (135/137). Malignancies, including 82 lung cancers, were diagnosed in 97 nodules (70.8%). CONCLUSION The injection of a lower dose PBD based on the distance to the visceral pleura can be successful with nodular localization and may facilitate thoracoscopic surgery, even in cases with a long interval from localization to surgery.
Collapse
Affiliation(s)
- Kai-Hsiung Ko
- Department of Radiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Tsai-Wang Huang
- Department of Thoracic Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Shih-Chun Lee
- Department of Thoracic Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Wei-Chou Chang
- Department of Radiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Hong-Wei Gao
- Department of Pathology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Hsian-He Hsu
- Department of Radiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China.
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Li C, Liu B, Jia H, Dong Z, Meng H. Computed tomography-guided hook wire localization facilitates video-assisted thoracoscopic surgery of pulmonary ground-glass nodules. Thorac Cancer 2018; 9:1145-1150. [PMID: 30047619 PMCID: PMC6119612 DOI: 10.1111/1759-7714.12801] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 06/15/2018] [Accepted: 06/16/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND This retrospectively study was conducted to assess the efficiency and safety of computed tomography (CT)-guided hook wire localization of pulmonary ground-glass nodules (GGNs) prior to video-assisted thoracoscopic surgery (VATS). METHODS From 2015 to 2018, a total of 86 patients with 86 pulmonary GGNs underwent preoperative CT-guided hook wire localization before VATS. The technical details and clinicopathological findings were analyzed. RESULTS All 86 pulmonary GGNs (25 pure GGNs and 61 part-solid GGNs) were successfully located and resected. The mean diameter of the GGNs was 1.4 ± 0.4 cm (range 0.6-2.2) and the mean lesion distance to the pleural surface was 7.3 ± 4.3 mm (range 2-19). Complications of hook wire marking included asymptomatic minor pneumothorax in 21 patients (24%) and focal pulmonary hemorrhage in 18 (21%). The median hook wire localization time was 19.1 minutes (range 10-30) and the median VATS time was 49 minutes (range 28-89). Pathology revealed 72 precancerous lesions or primary lung adenocarcinomas, 5 metastatic tumors, and 9 benign lesions. CONCLUSIONS Preoperative localization of small pulmonary GGNs using CT-guided hook wire was efficient and safe prior to VATS resection.
Collapse
Affiliation(s)
- Chunhai Li
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Bo Liu
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Haipeng Jia
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Zhenyu Dong
- Department of Radiology, Qingdao Huangdaoqu People's Hospital, Qingdao, China
| | - Hong Meng
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| |
Collapse
|
16
|
Kim MP, Nguyen DT, Chan EY, Meisenbach LM, Kopas LM, Graviss EA, Lumsden AB, Gupta N. Computed tomography criteria for the use of advanced localization techniques in minimally invasive thoracoscopic lung resection. J Thorac Dis 2018; 10:3390-3398. [PMID: 30069334 DOI: 10.21037/jtd.2018.05.54] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The significant improvement of patient outcomes from minimally invasive lung surgery has led to the development of advanced lung nodule localization techniques to help manage patients with small suspicious lung nodules or to help resect patients with small pulmonary metastases. However, there are no clear computed tomography (CT) criteria to guide the use of advanced localization techniques for this group of patients. Methods We conducted a retrospective chart review of patients who had undergone initial wedge resection of single or multiple lung nodules. We collected demographics, surgical information and surgical outcomes as well as CT scan features. Multiple logistic regression was performed to determine which factors were most predictive of the need for advanced localization techniques. Results A total of 45 patients (73%) were resected by direct identification alone while 17 patients (27%) required advanced localization techniques. Of those requiring advanced localization, 11 patients had cone beam CT, 3 patients had transbronchial localization using electromagnetic navigation and 3 patients had preoperative CT guided wire localization. Patients requiring advanced localization had significantly smaller lung nodules at 0.8 cm compared to 1.4 cm (P=0.01), nodules that were further away from the pleura at 1.3 cm compared 0.1 cm (P<0.001) and were more likely to have ground glass nodules (P=0.01) compared to patients who were resected by direct identification alone. Multiple logistic regression confirmed that nodule size, distance to pleura and ground glass attenuation were predictive factors for requiring advanced localizing techniques. Every patient was treated with minimally invasive lung resection. A 1.3-cm or greater solitary pulmonary nodule less than 5 mm from the pleura can be removed without advanced techniques with a 96% success rate. Conclusions Overall, in patients undergoing resection of a suspicious primary or metastatic lung nodule, advanced localization techniques should be considered in those with small non-solid nodules, which are not near the pleural surface on CT scan.
Collapse
Affiliation(s)
- Min P Kim
- Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, TX, USA.,Department of Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA
| | - Duc T Nguyen
- Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Edward Y Chan
- Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, TX, USA.,Department of Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA
| | - Leonora M Meisenbach
- Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Lisa M Kopas
- Pulmonary Critical Care & Sleep Medicine Consultants, Houston, TX, USA
| | - Edward A Graviss
- Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Alan B Lumsden
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Nakul Gupta
- Department of Radiology, Houston Methodist Hospital, Houston, TX, USA
| |
Collapse
|
17
|
Fysh ET, Thomas R, Tobin C, Kuok YJ, Lee YCG. Air in the Pleural Cavity Enhances Detection of Pleural Abnormalities by CT Scan. Chest 2018; 153:e123-e128. [DOI: 10.1016/j.chest.2018.02.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/06/2018] [Accepted: 02/01/2018] [Indexed: 01/14/2023] Open
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
Hsieh CP, Hsieh MJ, Fang HY, Chao YK. Imaging-guided thoracoscopic resection of a ground-glass opacity lesion in a hybrid operating room equipped with a robotic C-arm CT system. J Thorac Dis 2017; 9:E416-E419. [PMID: 28616298 DOI: 10.21037/jtd.2017.04.48] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The intraoperative identification of small pulmonary nodules through video-assisted thoracoscopic surgery remains challenging. Although preoperative CT-guided nodule localization is commonly used to detect tumors during video-assisted thoracoscopic surgery (VATS), this approach carries inherent risks. We report the case of a patient with stage I lung cancer presenting as an area of ground-glass opacity (GGO) in the right upper pulmonary lobe. He successfully underwent a single-stage, CT-guided localization and removal of the pulmonary nodule within a hybrid operating room (OR) equipped with a robotic C-arm.
Collapse
Affiliation(s)
- Chen-Ping Hsieh
- Division of Thoracic Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Thoracic Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Ming-Ju Hsieh
- Division of Thoracic Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsin-Yueh Fang
- Division of Thoracic Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yin-Kai Chao
- Division of Thoracic Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|