1
|
Zhang H, Zhang X, Li Y, Huang Z, Liu H, Chen X. The efficacy and safety of CT-guided localization of pulmonary nodules by medical adhesives containing methylene blue before surgery. Heliyon 2024; 10:e31404. [PMID: 38832261 PMCID: PMC11145235 DOI: 10.1016/j.heliyon.2024.e31404] [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: 07/22/2023] [Revised: 05/15/2024] [Accepted: 05/15/2024] [Indexed: 06/05/2024] Open
Abstract
Background The accurate preoperative localization of pulmonary nodules is essential for a successful video-assisted thoracic surgery (VATS). The aim of this research was to clarify the efficacy and safety of CT-guided localization of pulmonary nodules by mixture of methylene blue and medical adhesive. Methods Between January 2020 and January 2021, 103 subjects who have received the CT-guidance pulmonary nodules localization operation were included and retrospectively analyzed. The data on efficiency and complications of preoperative localization using medical adhesives mixed with methylene blue mixture were collected and analyzed. Results 103 patients with 111 localized pulmonary nodules were included, 95 of whom had one nodule and 8 of whom had two nodules. The nodule localization success rate reaches as high as 100 %. The mean diameter of pulmonary nodules was 9.50 ± 3.67 mm. The mean distance of pulmonary nodule and pleural surface was 19.95 ± 14.92 mm. The mean depth of localized adhesive in the lung parenchyma was 18.99 ± 11.62 mm, and the mean time required for localization was 16.98 ± 5.72 min. The average time from the nodule localization to VATS surgery was 16.97 ± 7.34 h. The common complications of localization were minor pulmonary hemorrhage (9.74 %) and mild pneumothorax (15.53 %). Besides, pulmonary hemorrhage was related with depths of medical adhesives and nodules in lung parenchyma (p = 0.018 and 0.002, respectively). Conclusion Medical adhesive mixed with methylene blue is safe and effective in pulmonary nodules localization for VATS, and surgeons have flexibility in scheduling the procedure.
Collapse
Affiliation(s)
- Huijun Zhang
- Department of Cardiothoracic Surgery, Huashan Hospital of Fudan University, Shanghai, 200040, China
| | - Xiujuan Zhang
- Department of Pulmonary and Critical Care Medicine, Huashan Hospital of Fudan University, Shanghai, 200040, China
| | - Ying Li
- Department of Cardiothoracic Surgery, Shanghai Pulmonary Hospital, Shanghai, 200433, China
| | - Zhifei Huang
- Department of Radiation Oncology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, 233000, Anhui, China
| | - Huahua Liu
- Nursing Department of the Eighth People's Hospital of Shanghai, Shanghai, 200235, China
| | - Xiaofeng Chen
- Department of Cardiothoracic Surgery, Huashan Hospital of Fudan University, Shanghai, 200040, China
| |
Collapse
|
2
|
Lin J, Zhang J, Wei N, Wu AL, Wang LF, Teng F, Xian YT, Han R. Comparison of indocyanine green and blue-stained glue for preoperative localization for pulmonary nodules. Front Oncol 2024; 14:1345288. [PMID: 38577330 PMCID: PMC10991676 DOI: 10.3389/fonc.2024.1345288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/12/2024] [Indexed: 04/06/2024] Open
Abstract
Background In patients with pulmonary nodules undergoing computed tomography (CT)-guided localization procedures, a range of liquid-based materials have been employed to date in an effort to guide video-assisted thoracoscopic surgery (VATS) procedures to resect target nodules. However, the relative performance of these different liquid-based localization strategies has yet to be systematically evaluated. Accordingly, this study was developed with the aim of examining the relative safety and efficacy of CT-guided indocyanine green (IG) and blue-stained glue (BSG) PN localization. Methods Consecutive patients with PNs undergoing CT-guided localization prior to VATS from November 2021 - April 2022 were enrolled in this study. Safety and efficacy outcomes were compared between patients in which different localization materials were used. Results In total, localization procedures were performed with IG for 121 patients (140 PNs), while BSG was used for localization procedures for 113 patients (153 PNs). Both of these materials achieved 100% technical success rates for localization, with no significant differences between groups with respect to the duration of localization (P = 0.074) or visual analog scale scores (P = 0.787). Pneumothorax affected 8 (6.6%) and 8 (7.1%) patients in the respective IG and BSG groups (P = 0.887), while 12 (9.9%) and 10 (8.8%) patients of these patients experienced pulmonary hemorrhage. IG was less expensive than BSG ($17.2 vs. $165). VATS sublobar resection procedure technical success rates were also 100% in both groups, with no instances of conversion to thoracotomy. Conclusions IG and BSG both offer similarly high levels of clinical safety and efficacy when applied for preoperative CT-guided PN localization, with IG being less expensive than BSG.
Collapse
Affiliation(s)
- Jia Lin
- Department of Interventional Radiology, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Jia Zhang
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, China
| | - Ning Wei
- Department of Interventional Radiology, The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital), Hefei, China
| | - An-Le Wu
- Department of Interventional Radiology, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Long-Fei Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Fei Teng
- Department of Interventional Radiology, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Yu-Tao Xian
- Department of Interventional Radiology, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Rui Han
- Department of Interventional Radiology, The First Affiliated Hospital of Ningbo University, Ningbo, China
| |
Collapse
|
3
|
Wang Y, Jing L, Liang C, Liu J, Wang S, Wang G. Comparison of the safety and effectiveness of the four-hook needle and hook wire for the preoperative positioning of localization ground glass nodules. J Cardiothorac Surg 2024; 19:35. [PMID: 38297385 PMCID: PMC10829251 DOI: 10.1186/s13019-024-02497-1] [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: 03/03/2023] [Accepted: 01/14/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND With the implementation of lung cancer screening programs, an increasing number of pulmonary nodules have been detected.Video-assisted thoracoscopic surgery (VATS) could provide adequate tissue specimens for pathological analysis, and has few postoperative complications.However, locating the nodules intraoperatively by palpation can be difficult for thoracic surgeons. The preoperative pulmonary nodule localization technique is a very effective method.We compared the safety and effectiveness of two methods for the preoperative localization of pulmonary ground glass nodules. METHODS From October 2020 to April 2021, 133 patients who underwent CT-guided single pulmonary nodule localization were retrospectively reviewed. All patients underwent video-assisted thoracoscopic surgery (VATS) after successful localization. Statistical analysis was used to evaluate the localization accuracy, safety, information related to surgery and postoperative pathology information. The aim of this study was to evaluate the clinical effects of the two localization needles. RESULTS The mean maximal transverse nodule diameters in the four-hook needle and hook wire groups were 8.97 ± 3.85 mm and 9.00 ± 3.19 mm, respectively (P = 0.967). The localization times in the four-hook needle and hook wire groups were 20.58 ± 2.65 min and 21.43 ± 3.06 min, respectively (P = 0.09). The dislodgement rate was significantly higher in the hook wire group than in the four-hook needle group (7.46% vs. 0, P = 0.024). The mean patient pain scores based on the visual analog scale in the four-hook needle and hook wire groups were 2.87 ± 0.67 and 6.10 ± 2.39, respectively (P = 0.000). All ground glass nodules (GGNs) were successfully resected by VATS. CONCLUSIONS Preoperative pulmonary nodule localization with both a four-hook needle and hook wire is safe, convenient and effective.
Collapse
Affiliation(s)
- Yongming Wang
- Department of Thoracic Surgery, Shandong Provincial Hospital, Shandong University, Jinan, 250021, Shandong, China
- Department of Thoracic Surgery, Weifang No.2 Peoplès Hospital, Weifang, 261041, Shandong, China
| | - Lijun Jing
- Department of Anesthesiology, Weifang No.2 Peoplès Hospital, Weifang, 261041, Shandong, China
| | - Changsheng Liang
- Department of Radiology, Weifang No.2 Peoplès Hospital, Weifang, 261041, Shandong, China
| | - Junzhong Liu
- Department of Radiology, Weifang No.2 Peoplès Hospital, Weifang, 261041, Shandong, China
| | - Shubo Wang
- Department of Thoracic Surgery, Weifang No.2 Peoplès Hospital, Weifang, 261041, Shandong, China
| | - Gongchao Wang
- Department of Thoracic Surgery, Shandong Provincial Hospital, Shandong University, Jinan, 250021, Shandong, China.
| |
Collapse
|
4
|
Lin Z, Yang GM, Ye XB, Liu XB, Chen SS, Zhang YL, Zhuo PQ. Clinical application of two types of Hook-Wire needle localization procedures for pulmonary small nodule biopsy. Technol Health Care 2024; 32:313-320. [PMID: 38669497 PMCID: PMC11191456 DOI: 10.3233/thc-248027] [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] [Indexed: 04/28/2024]
Abstract
BACKGROUND With the widespread use of low-dose spiral computed tomography (LDCT) and increasing awareness of personal health, the detection rate of pulmonary nodules is steadily rising. OBJECTIVE To evaluate the success rate and safety of two different models of Hook-Wire needle localization procedures for pulmonary small nodule biopsy. METHODS Ninety-four cases with a total of 97 pulmonary small nodules undergoing needle localization biopsy were retrospectively analyzed. The cases were divided into two groups: Group A, using breast localization needle steel wire (Bard Healthcare Science Co., Ltd.); Group B, using disposable pulmonary nodule puncture needle (SensCure Biotechnology Co., Ltd.). All patients underwent video-assisted thoracoscopic surgery (VATS) for nodule removal on the same day after localization and biopsy. The puncture localization operation time, success rate, complications such as pulmonary hemorrhage, pneumothorax, hemoptysis, and postoperative comfort were observed and compared. RESULTS In Group A, the average localization operation time for 97 nodules was 15.47 ± 5.31 minutes, with a success rate of 94.34%. The complication rate was 71.69% (12 cases of pneumothorax, 35 cases of pulmonary hemorrhage, 2 cases of hemoptysis), and 40 cases of post-localization discomfort were reported. In Group B, the average localization operation time was 25.32 ± 7.83 minutes, with a 100% success rate. The complication rate was 29.55% (3 cases of pneumothorax, 15 cases of pulmonary hemorrhage, 0 cases of hemoptysis), and 3 cases reported postoperative discomfort. According to the data analysis in this study, Group B had a lower incidence of puncture-related complications than Group A, along with a higher success rate and significantly greater postoperative comfort. CONCLUSIONS The disposable pulmonary nodule puncture needle is safer and more effective in pulmonary small nodule localization biopsy, exhibiting increased comfort compared to the breast localization needle. Additionally, the incidence of complications is significantly lower.
Collapse
Affiliation(s)
- Zhong Lin
- Department of Radiology, Xiamen Chang Gung Hospital Hua Qiao University, Fujian, China
| | - Guang-Ming Yang
- Department of Radiology, Xiamen Chang Gung Hospital Hua Qiao University, Fujian, China
| | - Xiu-Bi Ye
- Department of Ultrasound, Xin Yang Street Health Service Center, Xiamen, Fujian, China
| | - Xiang-Bo Liu
- Department of Radiology, Xiamen Chang Gung Hospital Hua Qiao University, Fujian, China
| | - Song-Sen Chen
- Department of Interventional Radiology, the Second Affiliated Hospital of Xiamen Medical College, Fujian, China
| | - Yu-Ling Zhang
- Department of Radiology, Xiamen Chang Gung Hospital Hua Qiao University, Fujian, China
| | - Pi-Qi Zhuo
- Department of Radiology, Xiamen Chang Gung Hospital Hua Qiao University, Fujian, China
| |
Collapse
|
5
|
Wang L, He J, Zhang L, Chen C, Chen B, Shen W. A novel preoperative image-guided localization for small pulmonary nodule resection using a claw-suture device. Sci Rep 2023; 13:18950. [PMID: 37919528 PMCID: PMC10622521 DOI: 10.1038/s41598-023-46365-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/31/2023] [Indexed: 11/04/2023] Open
Abstract
Video-assisted thoracoscopic surgery (VATS) provides better option concerning pathological diagnosis and curative intention of small pulmonary nodules (SPNs) that are sometimes challenging to localize. We assess the safety and feasibility of a new localization technique for SPNs, and report experience accumulated over time. A retrospective review of the new claw-suture localization cases between February 2018 and May 2023 was performed. Nodules were localized by a novel system that has an anchor claw and a tri-colored suture, guided by computed tomography (CT). Localization and operative procedure outcomes were then assessed. A total of 590 SPNs were localized from 568 patients before operation. The median nodule size was 0.70 cm (range, 0.3-2.0 cm). The claw-suture localization was successful without dislodgment or device fracture in 574 of 590 lesions (97.3%). Failures included not meeting target distance between claw and lesion (n = 13 [2.2%]), and device displacement (n = 3 [0.5%]). Complications requiring no further medical intervention included asymptomatic pneumothorax (n = 68 [11.5%]), parenchymal hemorrhage (n = 51 [8.6%]), and hemothorax (n = 1 [0.2%]) with the exception of pleural reaction observed in 2 cases (0.3%). Additionally, the depth of pulmonary nodules was significantly associated with the occurrence of pneumothorax (P = 0.036) and parenchymal hemorrhage (P = 0.000). The median duration of the localization was 12 min (range, 7-25 min). No patient complained of remarkable pain during the entire procedure. Retrieve of device after operation was 100%. The new localization technique is a safe, feasible, and well-tolerated method to localize SPNs for VATS resection.
Collapse
Affiliation(s)
- Lijie Wang
- Department of Thoracic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, 1111 Jiangnan Road, Ningbo, 315040, Zhejiang, China.
| | - Jinxian He
- Department of Thoracic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, 1111 Jiangnan Road, Ningbo, 315040, Zhejiang, China
| | - Liang Zhang
- Department of Respiration, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, 315040, Zhejiang, China
| | - Chengcheng Chen
- Department of Radiology, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, 315040, Zhejiang, China
| | - Biao Chen
- Department of Thoracic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, 1111 Jiangnan Road, Ningbo, 315040, Zhejiang, China
| | - Weiyu Shen
- Department of Thoracic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, 1111 Jiangnan Road, Ningbo, 315040, Zhejiang, China
| |
Collapse
|
6
|
Wei W, Wang SG, Zhang JY, Togn XY, Li BB, Fang X, Pu RW, Zhou YJ, Liu YJ. Implementation of Individualized Low-Dose Computed Tomography-Guided Hook Wire Localization of Pulmonary Nodules: Feasibility and Safety in the Clinical Setting. Diagnostics (Basel) 2023; 13:3235. [PMID: 37892056 PMCID: PMC10606229 DOI: 10.3390/diagnostics13203235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/06/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Background: CT-guided hook-wire localization is an essential step in the management of small pulmonary nodules. Few studies, however, have focused on reducing radiation exposure during the procedure. Purpose: This study aims to explore the feasibility of implementing a low-dose computed tomography (CT)-guided hook wire localization using tailored kVp based on patients' body size. Materials and Methods: A total of 151 patients with small pulmonary nodules were prospectively enrolled for CT-guided hook wire localization using individualized low-dose CT (LDCT) vs. standard-dose CT (SDCT) protocols. Radiation dose, image quality, characteristics of target nodules and procedure-related variables were compared. All variables were analyzed using Chi-Square and Student's t-test. Results: The mean CTDIvol was significantly reduced for LDCT (for BMI ≤ 21 kg/m2, 0.56 ± 0.00 mGy and for BMI > 21 kg/m2, 1.48 ± 0.00 mGy) when compared with SDCT (for BMI ≤ 21 kg/m2, 5.24 ± 0.95 mGy and for BMI > 21 kg/m2, 6.69 ± 1.47 mGy). Accordingly, the DLP of LDCT was significantly reduced as compared with that of SDCT (for BMI ≤ 21 kg/m2, 56.86 ± 4.73 vs. 533.58 ± 122.06 mGy.cm, and for BMI > 21 kg/m2, 167.02 ± 38.76 vs. 746.01 ± 230.91 mGy.cm). In comparison with SDCT, the effective dose (ED) of LDCT decreased by an average of 89.42% (for BMI ≤ 21 kg/m2) and 77.68% (for BMI > 21 kg/m2), respectively. Although the images acquired with the LDCT protocol yielded inferior quality to those acquired with the SDCT protocol, they were clinically acceptable for hook wire localization. Conclusions: LDCT-guided localization can provide safety and nodule detection performance comparable to SDCT-guided localization, benefiting radiation dose reduction dramatically, especially for patients with small body mass indexes.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Yu-Jing Zhou
- Correspondence: (Y.-J.Z.); (Y.-J.L.); Tel.: +86-180-9887-7000 (Y.J.-L.)
| | - Yi-Jun Liu
- Correspondence: (Y.-J.Z.); (Y.-J.L.); Tel.: +86-180-9887-7000 (Y.J.-L.)
| |
Collapse
|
7
|
Wang L, Shen S, Qu T, Feng T, Huang X, Chi R, Hu F, Xiao H. Feasibility and safety of computed tomography-guided intrapulmonary injection of indocyanine green for localization of peripheral pulmonary ground-glass nodules. Quant Imaging Med Surg 2023; 13:7052-7064. [PMID: 37869325 PMCID: PMC10585534 DOI: 10.21037/qims-23-117] [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: 01/30/2023] [Accepted: 09/04/2023] [Indexed: 10/24/2023]
Abstract
Background The early surgical intervention for pulmonary ground-glass nodules (GGNs) has become increasingly important, but accurate identification of these nodules during thoracoscopic surgery poses challenges due to the need for sublobar resections and reliance on visual and tactile perception alone. The prognosis of the procedure is closely tied to the use of precise positioning technology. Thus, it is crucial to develop an accurate positioning technology that can improve patient prognosis. Methods Clinical data from the cardiothoracic department of a tertiary hospital in Shanghai were collected and analyzed between January 2020 and December 2021. The patients were categorized into 2 groups: an indocyanine green (ICG) group and a hook-wire group. Outcome measures including success rate, complications, procedure time, localization-related pain, and interval time were assessed. Adverse events and reactions were reported and compared between the 2 groups. Results A total of 62 patients (17 males and 45 females, aged 50.5±13.2 years) were in the ICG group, while 66 patients (23 males and 43 females, aged 48.4±12.9 years) were localized in the hook-wire group. The success rate was comparable between the 2 groups. However, the ICG group showed significant advantages over the hook-wire group in terms of procedure time (22.6±4.4 vs. 24.1±4.9 min; P=0.012), localization-related pain (P<0.001), and interval time [median and interquartile range (IQR): 3 (0.7, 104.9) vs. 1.2 (0.5, 3.3) h; P<0.001]. In the ICG group, there were 11 cases of pneumothorax, 4 cases of hemothorax, and 2 cases of ICG diffusion. In the hook-wire group, there were 24 cases of pneumothorax, 25 cases of hemothorax, and 2 cases of dislodgement. The ICG group had fewer complications, including pneumothorax (P=0.018) and hemothorax (P=0.007), compared to the hook-wire group. Conclusions Computed tomography (CT)-guided intrapulmonary injection of ICG for preoperative localization of peripheral pulmonary GGNs is a practical and safe technique. It offers advantages in terms of reduced procedure time, localization-related pain, and interval time compared to the hook-wire method. Moreover, the ICG technique results in fewer complications, making it a valuable preoperative localization technique worthy of popularization.
Collapse
Affiliation(s)
- Lei Wang
- Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sai’e Shen
- Department of Anesthesiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tiantian Qu
- Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tienan Feng
- Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuequn Huang
- Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Runmin Chi
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fengqing Hu
- Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haibo Xiao
- Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
8
|
Yang Q, Han K, Lv S, Li Q, Sun X, Feng X, Kang M. Virtual navigation bronchoscopy-guided intraoperative indocyanine green localization in simultaneous surgery for multiple pulmonary nodules. Thorac Cancer 2022; 13:2879-2889. [PMID: 36058556 PMCID: PMC9575123 DOI: 10.1111/1759-7714.14633] [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: 07/04/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 12/01/2022] Open
Abstract
Background Accurate localization of pulmonary nodules is the main difficulty experienced in wedge resection. Commonly used localization methods have their own advantages and disadvantages. However, clinical work has demonstrated that intraoperative indocyanine green localization under electromagnetic navigation bronchoscopy/virtual navigation bronchoscopy (VNB) is more advantageous than conventional methods for patients with multiple pulmonary nodules undergoing simultaneous surgery, especially for those undergoing bilateral lung surgery. Methods Data of patients undergoing simultaneous surgery for multiple pulmonary nodules with preoperative methylene blue localization by computed tomography (CT)‐guided percutaneous lung puncture (methylene blue group) or intraoperative indocyanine green localization under VNB (virtual navigation group) were retrospectively analyzed. Patient characteristics, pulmonary nodule features, localization time, preoperative location time, location success rate, operation time, complication incidence, visceral pleural staining rate after localization, and pulmonary nodule primary resection success rate were compared between the two groups. Results The methylene blue and virtual navigation groups comprised 39 and 20 patients with 119 and 67 pulmonary nodules resected, respectively. Sex, age, number of pulmonary nodules resected simultaneously, unilateral/bilateral lung surgery, pulmonary nodule size, distance between pulmonary nodules and the visceral pleura, pulmonary nodule consolidation‐to‐tumor ratio, location of pulmonary nodules in the pulmonary lobe, postoperative pathology, visceral pleura staining rate, primary pulmonary nodule resection success rate, and surgical duration did not differ significantly between the groups (p > 0.05). The localization time of the virtual navigation group was significantly shorter than that of the methylene blue group (p < 0.05), regardless of unilateral or bilateral multiple nodules. In the methylene blue group, 25.64% (10/39) of patients presented complications, all of which were pneumothorax, whereas no complications were found in the virtual navigation group. Conclusions For patients with multiple pulmonary nodules undergoing simultaneous surgery, indocyanine green injection under VNB can achieve a similar effect on pulmonary nodule localization as classical methylene blue injection under CT‐guided percutaneous lung puncture, with shorter localization time and fewer complications.
Collapse
Affiliation(s)
- Qingjie Yang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, P. R. China.,Department of Thoracic Surgery, Xiamen Humanity Hospital of Fujian Medical University, Xiamen, P. R. China
| | - Kaibao Han
- Department of Thoracic Surgery, Xiamen Humanity Hospital of Fujian Medical University, Xiamen, P. R. China
| | - Shenghua Lv
- Department of Thoracic Surgery, Xiamen Humanity Hospital of Fujian Medical University, Xiamen, P. R. China
| | - Qingtian Li
- Department of Thoracic Surgery, Xiamen Humanity Hospital of Fujian Medical University, Xiamen, P. R. China
| | - Xiaoyan Sun
- Department of Thoracic Surgery, Xiamen Humanity Hospital of Fujian Medical University, Xiamen, P. R. China
| | - Xinhai Feng
- Department of Thoracic Surgery, Xiamen Humanity Hospital of Fujian Medical University, Xiamen, P. R. China
| | - Mingqiang Kang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, P. R. China.,Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, China.,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| |
Collapse
|
9
|
Lui NS, Singhal S. Intraoperative Molecular Imaging of Lung Cancer. Surg Oncol Clin N Am 2022; 31:685-693. [DOI: 10.1016/j.soc.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
10
|
Zhang H, Li Y, Chen X, He Z. Comparison of hook-wire and medical glue for CT-guided preoperative localization of pulmonary nodules. Front Oncol 2022; 12:922573. [PMID: 36003778 PMCID: PMC9393881 DOI: 10.3389/fonc.2022.922573] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/13/2022] [Indexed: 12/09/2022] Open
Abstract
BackgroundPreoperative localization is challenging due to the small diameter of pulmonary nodules or their deep location in the lung parenchyma during VATS surgery. The purpose of this study was to compare the efficacy and safety of both hook-wire and medical glue for pre-operative localization of pulmonary nodules.MethodsIn the current study, 158 patients were retrospectively analyzed (January 2019 and January 2020). The patients underwent hook-wire or medical glue for pre-operative localization of pulmonary nodules. Among them, 74 patients in the hook-wire group and 84 patients in the medical glue group underwent VATS anatomic segmentectomy or wedge resection after localization of pulmonary nodules. Pre-operative localization data from all patients were compiled. Moreover, the efficacy and safety of the two methods were evaluated according to localization success rates and localization-related complications.ResultsThe success rate of localization in the medical glue group was 100% while 97.3% in the hook-wire group. After localization of the pulmonary nodules, the incidence of minor pneumothorax in the medical glue group (11.9%) was lower than that in the hook-wire group (37.8%) (p=0.01). The incidence of mild pulmonary parenchymal hemorrhage in the medical glue group (13.1%) was also lower than that in the hook-wire group (24.3%) (p=0.000). The mean time from the completion of localization to the start of surgery was also longer in the medical glue group than in the hook-wire group (p=0.000). The mean visual analog scale (VAS) scores after localization were higher in the hook-wire group than in the medical glue group (p=0.02). In both groups, parenchymal hemorrhage was significantly associated with the needle length in hook-wire localization and the depth of the medical glue in the lung parenchyma (p = 0.009 and 0.001, respectively).ConclusionThese two localization methods are safe and effective in pre-operative pulmonary nodule localization. The medical glue localization method had a lower risk of complications, a higher localization success rate, less pain after localization and more flexibility in the arrangement of operation time.
Collapse
Affiliation(s)
- Huijun Zhang
- Department of Cardiothoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Huijun Zhang, ; Xiaofeng Chen, ; Zelai He,
| | - Ying Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Yangpu, Shanghai, China
| | - Xiaofeng Chen
- Department of Cardiothoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Huijun Zhang, ; Xiaofeng Chen, ; Zelai He,
| | - Zelai He
- Department of Radiation Oncology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, China
- *Correspondence: Huijun Zhang, ; Xiaofeng Chen, ; Zelai He,
| |
Collapse
|
11
|
Yin P, Yue B, Zhang J, Liu D, Bai D, Zhao G, Huang C, Geng G, Jiang J, Su Y, Yu X, Chen J. Optimal margins for early stage peripheral lung adenocarcinoma resection. BMC Cancer 2021; 21:533. [PMID: 33975545 PMCID: PMC8111997 DOI: 10.1186/s12885-021-08251-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/23/2021] [Indexed: 12/24/2022] Open
Abstract
Background A pathologically confirmed negative margin is required when performing sublobar resection in patients with early stage peripheral lung adenocarcinoma. However, the optimal margin distance to ensure complete tumor resection while preserving healthy lung tissue remains unknown. We aimed to establish a reliable distance range for negative margins. Methods A total of 52 intraoperative para-cancer tissue specimens from patients with peripheral lung adenocarcinoma with pathological tumors ≤2 cm in size were examined. Depending on the distance from the tumor edge (D), the para-cancer tissues were divided into the following five groups: D < 0.5 cm (group I); 0.5 cm ≤ D < 1.0 cm (group II); 1.0 cm ≤ D < 1.5 cm (group III); 1.5 cm ≤ D < 2.0 cm (group IV); and D ≥ 2.0 cm (group V). During pathological examination of the specimens under a microscope, the presence of atypical adenomatous hyperplasia or more severe lesions was considered unsafe, whereas the presence of normal lung tissue or benign hyperplasia was considered safe. Results Group V, in which the margin was the farthest from the tumor edge, was the safest. There were significant safety differences in between groups I and V (χ2 = 26.217, P < 0.001). Significant safety differences also existed between groups II and V (χ2 = 9.420, P < 0.005). There were no significant safety differences between group III or IV and group V (P = 0.207; P = 0.610). Conclusions We suggest that when performing sublobar resection in patients with early stage peripheral lung adenocarcinoma with pathological tumor sizes ≤2 cm, the resection margin distance should be ≥1 cm to ensure a negative margin.
Collapse
Affiliation(s)
- Pan Yin
- Wuxi Lung Transplant Center, Wuxi People's Hospital Affiliated to Nanjing Medical University, 299 QingYang Road, Wuxi, 214023, China
| | - Bingqing Yue
- Wuxi Lung Transplant Center, Wuxi People's Hospital Affiliated to Nanjing Medical University, 299 QingYang Road, Wuxi, 214023, China
| | - Ji Zhang
- Wuxi Lung Transplant Center, Wuxi People's Hospital Affiliated to Nanjing Medical University, 299 QingYang Road, Wuxi, 214023, China
| | - Dong Liu
- Wuxi Lung Transplant Center, Wuxi People's Hospital Affiliated to Nanjing Medical University, 299 QingYang Road, Wuxi, 214023, China
| | - Dongyu Bai
- Department of Pathology, The First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Xiamen, 361003, China
| | - Guang Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Xiamen, 361003, Fujian, China
| | - Chutong Huang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Xiamen, 361003, Fujian, China
| | - Guojun Geng
- Department of Thoracic Surgery, The First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Xiamen, 361003, Fujian, China
| | - Jie Jiang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Xiamen, 361003, Fujian, China
| | - Yongxiang Su
- Department of Thoracic Surgery, The First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Xiamen, 361003, Fujian, China
| | - Xiuyi Yu
- Department of Thoracic Surgery, The First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Xiamen, 361003, Fujian, China.
| | - Jingyu Chen
- Wuxi Lung Transplant Center, Wuxi People's Hospital Affiliated to Nanjing Medical University, 299 QingYang Road, Wuxi, 214023, China.
| |
Collapse
|
12
|
Imperatori A, Nardecchia E, Cattoni M, Mohamed S, Di Natale D, Righi I, Mendogni P, Diotti C, Rotolo N, Dominioni L, Rosso L. Perioperative identifications of non-palpable pulmonary nodules: a narrative review. J Thorac Dis 2021; 13:2524-2531. [PMID: 34012598 PMCID: PMC8107557 DOI: 10.21037/jtd-20-1712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Early detection of lung cancer is the key to improving treatment and prognosis of this disease, and the advent of advances in computed tomography (CT) imaging and national screening programs have improved the detection rate of very small pulmonary lesions. As such, the management of this sub-centimetric and often sub-solid lesions has become quite challenging for clinicians, especially for choosing the most suitable diagnostic method. In clinical practice, to fulfill this diagnostic yield, transthoracic needle biopsy (TTNB) is often the first choice especially for peripheral nodules. For lesions for which TTNB could present technical difficulties or failed, other diagnostic strategies are needed. In this case, video-assisted thoracic surgery (VATS) is the gold standard to reach the diagnosis of lung nodules suspect of being malignant. Nonetheless it’s often not easy the identification of such lesions during VATS because of their little dimensions, non-firm consistency, deep localization. In literature various marking techniques have been described, in order to improve intraoperative nodules detection and to reduce conversion rate to thoracotomy: CT-guided hookwire positioning, methylene blue staining, intra-operative ultrasound and electromagnetic navigation bronchoscopy are the most used. The scientific evidence on this matter is weak because there are no randomized clinical trials but only case series on single techniques with no comparison on efficacy, so there are no guidelines to refer. From this standing, in this article we conducted a narrative review of the existing literature on the subject, with the aim of outlining a framework as complete as possible. We analyzed strengths and weaknesses of the main techniques reported, so as to allow the clinician to orient himself with greater ease.
Collapse
Affiliation(s)
- Andrea Imperatori
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Elisa Nardecchia
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Maria Cattoni
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Shehab Mohamed
- Thoracic Surgery and Lung Transplant Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Davide Di Natale
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Ilaria Righi
- Thoracic Surgery and Lung Transplant Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Mendogni
- Thoracic Surgery and Lung Transplant Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Cristina Diotti
- Thoracic Surgery and Lung Transplant Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Rotolo
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Lorenzo Dominioni
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Lorenzo Rosso
- Thoracic Surgery and Lung Transplant Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
13
|
Baldwin DR, Callister MEJ. An update on CT screening for lung cancer: the first major targeted cancer screening programme. Br J Radiol 2020; 93:20200636. [PMID: 32894687 DOI: 10.1259/bjr.20200636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Screening for lung cancer with low radiation dose CT has been shown to be effective in reducing lung cancer mortality by two major randomised controlled trials. Lung cancer screening is set to become the largest targeted cancer screening programme globally, but the effectiveness of the programme is dependent on many different factors. This article describes the key evidence for lung cancer screening, the key factors important for optimisation and the progress towards implementation.
Collapse
Affiliation(s)
- David R Baldwin
- Nottingham University Hospitals and Honorary Professor, University of Nottingham, Respiratory Medicine Unit, David Evans Centre, Nottingham, United Kingdom
| | | |
Collapse
|
14
|
Liao M, He Z, Xu E, Wu D. [Value of preoperative localization techniques for solitary pulmonary nodules in singleport thoracoscopic surgery]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:718-722. [PMID: 32897207 DOI: 10.12122/j.issn.1673-4254.2020.05.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
ObjectiveTo evaluate the value and clinical effect of different preoperative localization techniques for solitary pulmonary nodules (SPN) before single-port thoracoscopic surgery.MethodFrom January 2018 to June 2019, 54 patients diagnosed with solitary pulmonary nodules received single-port thoracoscopic surgery in Thoracic Department of General Hospital of Southern Theater Command of PLA. Based on the location methods of the nodules, the patients were divided into group A (34 cases) with preoperative CT-guided Hook-wire (a common positioning needle usually using in mammary gland) positioning and group B (20 cases) with preoperative CT-guided methylene blue location.ResultsThe success rate of localization in group A was 94.18% (32/34), significantly higher than that in group B [85% (17/20), P < 0.05). No intraoperative conversion to thoracotomy occurred in group A, while the conversion rate was 10% (2/20) in group B (P < 0.05). The average positioning cost was significantly higher in group A than in group B (1715±109 vs 1021±86 RMB yuan, P < 0.05), but the total hospitalization cost was similar between the two groups (50 114±3788 vs 47871±5902 RMB yuan, P>0.05). The length of hospital stay was significantly shorter in group A than in group B (6.71±1.23 vs 8.19±2.61 days, P < 0.05).ConclusionCompared with the traditional methylene blue localization method, Hook-wire localization positioning can significantly increase the success rate of localization, and can be used as the standard preoperative localization method in patients undergoing single-port thoracoscopic pulmonary nodule resection, especially in those with deep nodule location from the visceral pleura.
Collapse
Affiliation(s)
- Ming Liao
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Zhe He
- Department of Thoracic Surgery, General Hospital of Southern Theater Command, PLA, Guangzhou 510010, China
| | - Enwu Xu
- Department of Thoracic Surgery, General Hospital of Southern Theater Command, PLA, Guangzhou 510010, China
| | - Dehua Wu
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| |
Collapse
|