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Jiang Y, Deng T, Huang Y, Ren B, He L, Pang M, Jiang L. Developing a multi-institutional nomogram for assessing lung cancer risk in patients with 5-30 mm pulmonary nodules: a retrospective analysis. PeerJ 2023; 11:e16539. [PMID: 38107565 PMCID: PMC10725170 DOI: 10.7717/peerj.16539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 11/08/2023] [Indexed: 12/19/2023] Open
Abstract
Background The diagnosis of benign and malignant solitary pulmonary nodules based on personal experience has several limitations. Therefore, this study aims to establish a nomogram for the diagnosis of benign and malignant solitary pulmonary nodules using clinical information and computed tomography (CT) results. Methods Retrospectively, we collected clinical and CT characteristics of 1,160 patients with pulmonary nodules in Guang'an People's Hospital and the hospital affiliated with North Sichuan Medical College between 2019 and 2021. Among these patients, data from 773 patients with pulmonary nodules were used as the training set. We used the least absolute shrinkage and selection operator (LASSO) to optimize clinical and imaging features and performed a multivariate logistic regression to identify features with independent predictive ability to develop the nomogram model. The area under the receiver operating characteristic curve (AUC), C-index, decision curve analysis, and calibration plot were used to evaluate the performance of the nomogram model in terms of predictive ability, discrimination, calibration, and clinical utility. Finally, data from 387 patients with pulmonary nodules were utilized for validation. Results In the training set, the predictors for the nomogram were gender, density of the nodule, nodule diameter, lobulation, calcification, vacuole, vascular convergence, bronchiole, and pleural traction, selected through LASSO and logistic regression analysis. The resulting model had a C-index of 0.842 (95% CI [0.812-0.872]) and AUCs of 0.842 (95% CI [0.812-0.872]). In the validation set, the C-index was 0.856 (95% CI [0.811-0.901]), and the AUCs were 0.844 (95% CI [0.797-0.891]). Results from the calibration curve and clinical decision curve analyses indicate that the nomogram has a high fit and clinical benefit in both the training and validation sets. Conclusion The establishment of a nomogram for predicting the benign or malignant diagnosis of solitary pulmonary nodules by this study has shown good efficacy. Such a nomogram may help to guide the diagnosis, follow-up, and treatment of patients.
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Affiliation(s)
- Yongjie Jiang
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Taibing Deng
- Department of Respiratory and Critical Care Medicine, Guang’an People’s Hospital, Guang’an, Sichuan, China
| | - Yuyan Huang
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Bi Ren
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Liping He
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Min Pang
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Li Jiang
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
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Yu S, Li W, Liu X, Chen X, He X, Duan X, Zhang N, Yan Z, Zhang L. Application value of CT-guided localization using a coil in combination with medical adhesive in sublobar resection. Clin Transl Oncol 2023; 25:2931-2937. [PMID: 37020165 DOI: 10.1007/s12094-023-03156-y] [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: 12/28/2022] [Accepted: 03/14/2023] [Indexed: 04/07/2023]
Abstract
PURPOSE To explore the application value of CT-guided localization using a coil in combination with medical adhesive in sublobar resection. METHODS The clinical data of 90 patients who had small pulmonary nodules and received thoracoscopic sublobar resection during the period from September 2021 to October 2022 in the Department of Thoracic Surgery, Juxian People's Hospital, Shandong Province, were retrospectively analyzed. RESULTS The diameters of 95 pulmonary nodules in the 90 patients in the whole group ranged from 0.40 to 1.24 cm, and their distances from the visceral pleura ranged from 0.51 to 2.15 cm. In these patients, percutaneous lung puncture was successfully performed under local anesthesia, through which coils were implanted in the nodules and medical adhesive was injected around the nodules, with a success rate of localization of 100%. Localization complications included 10 cases of asymptomatic pneumothorax, 9 cases of intrapulmonary hemorrhage, 5 cases of severe pain, and 1 case of pleural reaction, all of which required no special treatment. After preoperative localization, the success rate of resection of pulmonary nodules was 100%, and sufficient surgical margins were obtained. CONCLUSION CT-guided localization using a coil in combination with medical adhesive is a safe, effective, and simple localization method that can meet the requirements of thoracic surgeons for intraoperative localization; for small pulmonary nodules, especially those small-sized and deep-located ground-glass nodules containing few solid mass, this method has important clinical application value, which is a preoperative localization technique worthy of wide application in clinical practice.
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Affiliation(s)
- Shanhai Yu
- Department of Thoracic Surgery, Juxian People's Hospital, Rizhao, 276599, Shandong, China
| | - Wei Li
- Department of Thoracic Surgery, Juxian People's Hospital, Rizhao, 276599, Shandong, China
| | - Xiangding Liu
- Department of Thoracic Surgery, Juxian People's Hospital, Rizhao, 276599, Shandong, China
| | - Xiuguo Chen
- Department of Thoracic Surgery, Juxian People's Hospital, Rizhao, 276599, Shandong, China
| | - Xiaolong He
- Department of Interventional Medicine, Juxian People's Hospital, Rizhao, 276599, Shandong, China
| | - Xianling Duan
- Department of Thoracic Surgery, Juxian People's Hospital, Rizhao, 276599, Shandong, China
| | - Nianxin Zhang
- Department of Thoracic Surgery, Juxian People's Hospital, Rizhao, 276599, Shandong, China
| | - Zhizhong Yan
- Department of Thoracic Surgery, Juxian People's Hospital, Rizhao, 276599, Shandong, China
| | - Liwei Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 South Liyushan Road, Xinshi District, Ürümqi, 830054, Xinjiang Uygur Autonomous Region, China.
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Ala M, Liu J, Kou J, Wang X, Sun M, Hao C, Wu J. The risk factors for the failure of hook wire localization of ground glass nodules prior to thoracoscopic surgery. J Cardiothorac Surg 2022; 17:114. [PMID: 35546677 PMCID: PMC9092699 DOI: 10.1186/s13019-022-01866-y] [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: 08/26/2021] [Accepted: 03/20/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives To retrospectively analyse the potential influencing factors of CT-guided hook wire localization failure prior to thoracoscopic resection surgery of ground glass nodules (GGNs), and determine the main risk elements for localization failure. Methods In all, 372 patients were included in this study, with 21 patients showing localization failure. The related parameters of patients, GGNs, and localization were analysed through univariate and multiple logistic regression analysis to determine the risk factors of localization failure. Results Univariate logistic regression analysis indicated that trans-fissure (odds ratio [OR] 4.896, 95% confidence interval [CI] 1.489–13.939); trans-emphysema (OR 3.538, 95% CI 1.343–8.827); localization time (OR 0.956, 95% CI 0.898–1.019); multi-nodule localization (OR 2.597, 95% CI 1.050–6.361); and pneumothorax (OR 10.326, 95% CI 3.414–44.684) were risk factors for localization failure, and the p-values of these factors were < 0.05. However, according to the results of multivariate analysis, pneumothorax (OR 5.998, 95% CI 1.680–28.342) was an exclusive risk factor for the failure of preoperative localization of GGNs. Conclusion CT-guided hook wire localization of GGNs prior to thoracoscopic surgery is often known to fail; however, the incidence is low. Pneumothorax is an independent risk factor for failure in the localization process.
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Affiliation(s)
- Musu Ala
- Graduate School, Tianjin Medical University, Tianjin, 300070, People's Republic of China.,Department of Ultrasound, The Affiliated Hospital of Inner Mongolia Medial University, Hohhot, Inner Mongolia, 010050, People's Republic of China
| | - Junzhong Liu
- Department of Radiology, Weifang People's Hospital, The First Affiliated Hospital of Weifang Medical University, Weifang, 261041, Shandong, People's Republic of China
| | - Jieli Kou
- Department of Medical Imaging, Cangzhou People's Hospital, Cangzhou, 061001, Hebei, People's Republic of China
| | - Xinhua Wang
- Department of Radiology, Weifang No. 2 People's Hospital, The Second Affiliated Hospital of Weifang Medical University, Weifang, 261041, Shandong, People's Republic of China
| | - Minfeng Sun
- Department of Radiology, Weifang No. 2 People's Hospital, The Second Affiliated Hospital of Weifang Medical University, Weifang, 261041, Shandong, People's Republic of China
| | - Changcheng Hao
- Thoracic Surgery Department, Weifang No. 2 People's Hospital, The Second Affiliated Hospital of Weifang Medical University, Weifang, 261041, Shandong, People's Republic of China
| | - Jianlin Wu
- Graduate School, Tianjin Medical University, Tianjin, 300070, People's Republic of China. .,Department of Medical Imaging, Affiliated Zhongshan Hospital of Dalian University, 6 Jiefang Street, Dalian, 116001, Liaoning, People's Republic of China.
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Jeong JH, Park H, Choi CM, Oh JH, Lee GD, Kim DK, Hwang HS, Jang SJ, Oh SY, Kim MY, Ji W. Preoperative electromagnetic navigation bronchoscopy-guided one-stage multiple-dye localization for resection of subsolid nodules: A single-center pilot study. Thorac Cancer 2021; 13:466-473. [PMID: 34951133 PMCID: PMC8807268 DOI: 10.1111/1759-7714.14283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 12/02/2021] [Accepted: 12/04/2021] [Indexed: 01/15/2023] Open
Abstract
Background Electromagnetic navigation bronchoscopy (ENB)‐guided transbronchial dye marking and video‐assisted thoracoscopic surgery (VATS) is an emerging technique that enables successful resection of multiple small subsolid pulmonary nodules. The aim of this study was to evaluate the accuracy and safety of preoperative ENB‐guided transbronchial multiple dye localization for VATS resection of subsolid pulmonary nodules. Methods As a single‐center pilot study, we recruited patients with at least two small or subsolid pulmonary nodules. Multiple‐dye localization was performed by intraoperative ENB‐guided transbronchial injection of an indigo carmine dye. The patients underwent VATS for sublobar resection immediately after localization. The accuracy of ENB‐guided dye marking was checked. Results ENB‐guided one‐stage multiple dye localization was conducted for 18 pulmonary nodules in seven patients between September 2018 and December 2019. The mean diameter of the pulmonary nodules was 9.3 mm (range, 4–18) and the mean distance from the pleura to pulmonary nodule was 6 mm (range, 1–17 mm). ENB‐guided transbronchial multiple dye localization was successfully performed in 94.4% (17/18), and the accuracy of ENB‐guided dye marking was 88.2% (15/17). When two nodules were not seen in intraoperative fields, anatomical sublobar resection was performed. There was no conversion to thoracotomy and operative mortalities. Among the seven patients, only one patient showed mild intrabronchial bleeding but stopped spontaneously. The changes in lung function after multiple wedge resections (−1.6% to 24.8%) were tolerable level. Conclusions ENB‐guided one‐stage transbronchial dye localization showed accurate and safe intraoperative identification of multiple subsolid pulmonary nodules. A large scale prospective clinical study is warranted.
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Affiliation(s)
- Jong Hwan Jeong
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyeongbin Park
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Chang-Min Choi
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ju Hyun Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Geun Dong Lee
- Division of Thoracic and Cardiovascular Surgery, Department of Internal Medicine, Ewha woman's University college of medicine, Seoul, South Korea
| | - Dong Kwan Kim
- Division of Thoracic and Cardiovascular Surgery, Department of Internal Medicine, Ewha woman's University college of medicine, Seoul, South Korea
| | - Hee Sang Hwang
- Department of Pathology, Asan Medical Center, Seoul, South Korea
| | - Se Jin Jang
- Department of Pathology, Asan Medical Center, Seoul, South Korea
| | - Sang Young Oh
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Mi Young Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Wonjun Ji
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Piao Z, Han SJ, Cho HJ, Kang MW. Feasibility of electromagnetic navigation bronchoscopy-guided lung resection for pulmonary ground-glass opacity nodules. J Thorac Dis 2020; 12:2467-2473. [PMID: 32642153 PMCID: PMC7330407 DOI: 10.21037/jtd.2020.03.71] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background Recent advances in imaging modalities and recommended low-dose computed tomography screening programs have made it easier to diagnose early lung cancer. However, the diagnosis of small ground-glass nodules (GGNs) has been problematic due to inappropriate specimen procurement and failure of conventional percutaneous core needle biopsy. Thus, we aimed to evaluate the usefulness of electromagnetic navigation bronchoscopy (ENB)-guided video-assisted lung resection for not only the diagnosis but also treatment of GGNs. Methods From 2017 to 2019, 110 patients with suspicious lung cancer lesions that were not diagnosed by conventional procedure underwent ENB-guided lung resection. Among 35 cases of GGNs, 33 cases of localization were included in this study (two cup biopsy cases were excluded). We used SuperDimension™ for the ENB procedure. After general anesthesia, indigo carmine (0.3–0.5 mL) was injected, and GGNs were resected through video-assisted thoracoscopic surgery. Results Of the 33 GGNs, 16 were pure (2 adenocarcinomas in situ, 5 minimally invasive adenocarcinomas (MIAs), 3 adenocarcinomas, and 6 benign lesions) and 17 were mixed (1 MIA, 11 adenocarcinomas, and 5 benign lesions). The mean size of all lesions was 11.2±7.78 mm, mean distance to the pleura was 11.2±14.2 mm, and mean ENB procedure time was 18.8±8.88 minutes. Dye localization and surgical resection of GGN were successful in all cases. There was no procedure-related complication. Conclusions ENB is a feasible and highly accurate localization method for minimally invasive lung resection of small GGNs.
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Affiliation(s)
- Zhe Piao
- Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Sung Joon Han
- Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Hyun Jin Cho
- Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Min-Woong Kang
- Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
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Lee JW, Park CH, Lee SM, Jeong M, Hur J. Planting Seeds into the Lung: Image-Guided Percutaneous Localization to Guide Minimally Invasive Thoracic Surgery. Korean J Radiol 2020; 20:1498-1514. [PMID: 31606955 PMCID: PMC6791818 DOI: 10.3348/kjr.2019.0155] [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: 02/27/2019] [Accepted: 07/18/2019] [Indexed: 12/18/2022] Open
Abstract
Image-guided localization materials are constantly evolving, providing options for the localization of small pulmonary nodules to guide minimally invasive thoracic surgery. Several preoperative methods have been developed to localize small pulmonary lesions prior to video-assisted thoracic surgery. These localization techniques can be categorized into 4 groups according to the materials used: localization with metallic materials (hook-wire, microcoil, or spiral coil), localization with dye (methylene blue or indigo carmine), localization with contrast agents (lipiodol, barium, or iodine contrast agents), and radiotracers (technetium-99m). However, the optimal localization method has not yet been established. In this review article, we discuss the various localization techniques and the advantages and disadvantages of localization techniques as well as the available safety and efficacy data on these techniques.
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Affiliation(s)
- Ji Won Lee
- Department of Radiology, Pusan National University Hospital, Busan, Korea
| | - Chul Hwan Park
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Min Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Miri Jeong
- Department of Radiology, Pusan National University Hospital, Busan, Korea
| | - Jin Hur
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Liu J, Wang X, Wang Y, Sun M, Liang C, Kang L. Comparison of CT-guided localization using hook wire or coil before thoracoscopic surgery for ground glass nodules. Br J Radiol 2020; 93:20190956. [PMID: 32302215 DOI: 10.1259/bjr.20190956] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To compare two kinds of metal markers for preoperative localization of ground glass nodules (GGNs). METHODS We retrospectively investigated data from 198 cases of GGN localization and compared the success rate and complications of both approaches. RESULTS In the hook wire and coil groups, the success rates of CT-guided localization for GGNs were 99.2 and 98.7%, respectively (p = 1.000). The success rates of video-assisted thoracoscopic surgery in both groups were 100% without transthoracic surgery. The post-localization complication rates in the hook wire group and coil group were 36.9 and 32.9% (p = 0.568), and the postoperative complication rates in the hook wire and coil groups were 13.9 and 11.8%, respectively (p = 0.672). CONCLUSIONS Preoperative localization of GGNs with both hook wire and coil methods proved to be useful and effective. Both methods have acceptable preoperative and postoperative complication rates, but the localization and operation times were shorter for the hook wire group than the coil group. ADVANCES IN KNOWLEDGE Most of previous articles studied a single preoperative localization method. Few studies have compared the preoperative and postoperative methods for metal markers. This paper compared two preoperative localization methods for GGNs to provide clinical guidance.
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Affiliation(s)
- Junzhong Liu
- Graduate school, Tianjin Medical University, Tianjin, 300070, China.,Department of Radiology, Weifang No. 2 People's Hospital, Weifang, Shandong, 261041, China
| | - Xinhua Wang
- Department of Radiology, Weifang No. 2 People's Hospital, Weifang, Shandong, 261041, China
| | - Yongming Wang
- Department of Thoracic surgery, Weifang No. 2 People's Hospital, Weifang, Shandong, 261041, China
| | - Minfeng Sun
- Department of Radiology, Weifang No. 2 People's Hospital, Weifang, Shandong, 261041, China
| | - Changsheng Liang
- Department of Radiology, Weifang No. 2 People's Hospital, Weifang, Shandong, 261041, China
| | - Liqing Kang
- Graduate school, Tianjin Medical University, Tianjin, 300070, China.,Department of Medical Imaging, Cangzhou Central Hospital, Cangzhou Teaching Hospital of Tianjin Medical University, Cangzhou, Hebei, 061001, China
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Chen JR, Tseng YH, Lin MW, Chen HM, Chen YC, Chen MC, Lee YF, Chen JS, Chang YC. Safety and efficacy of computed tomography-guided dye localization using patent blue V for single lung nodule for video-assisted thoracoscopic surgery: a retrospective study. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:28. [PMID: 30854381 DOI: 10.21037/atm.2019.01.27] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background For invisible or impalpable lung nodules, video-assisted thoracoscopic surgery (VATS) has some limitations; some preoperative localization has been developed to overcome this limitation. This study aimed to assess the safety and efficacy of preoperative computed tomography (CT)-guided localization with patent blue V dye. Methods In this retrospective study, we examined patients with solitary pulmonary nodule undergoing preoperative CT-guided patent blue V dye localization from 2013 to 2015. We analyzed patients' demographic data, nodular features, and procedures undergone. Results We enrolled 282 patients (282 lung nodules; mean age: 56.6±11.6 years, with female preponderance) in this study. The mean size of nodules was 0.9±0.5 cm, and mean time of localization was 24 min. The leading complications after localization were asymptomatic pneumothorax (48 patients, 17%) and localized pulmonary hemorrhage (51 patients, 18%). Other rare complications included subcutaneous emphysema and hematoma. We noted two cases with intraoperative poor or fail dye localization. Most patients underwent wedge resection (221 patients, 78.4%) and segmentectomy (36 patients, 12.8%), whereas 25 patients underwent lobectomy (8.9%) after the intraoperative frozen histopathological study confirmed malignancy. Furthermore, postoperative hospital stay was 4.8±2.0 days. Few patients experienced postoperative complications such as empyema (n=1), air leakage (n=3), and chylothorax (n=1). Conclusions This study establishes that CT-guided dye localization is a safe and efficient method with rare severe complications and high success rate.
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Affiliation(s)
- Jing-Ru Chen
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taichung, Taiwan
| | - Yao-Hui Tseng
- Department of Medical Imaging, Cardinal Tien Hospital, Taipei, Taiwan
| | - Mong-Wei Lin
- Department of Surgery, National Taipei University Hospital and National Taiwan University College of Medicine, Taichung, Taiwan
| | - Hsin-Ming Chen
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taichung, Taiwan
| | - Yi-Chang Chen
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taichung, Taiwan
| | - Mei-Chi Chen
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taichung, Taiwan
| | - Yee-Fan Lee
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taichung, Taiwan
| | - Jin-Shing Chen
- Department of Surgery, National Taipei University Hospital and National Taiwan University College of Medicine, Taichung, Taiwan
| | - Yeun-Chung Chang
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taichung, Taiwan
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