Spiral wire localization of lung nodules: procedure effectiveness and oncological usefulness

Thoracoscopic Resection of Lung Nodules following CT-Guided Labeling in Children and Adolescents with Solid Tumors

Resection of lung metastases in children with solid tumors is regularly hampered by limited intraoperative detectability and relevant operative trauma of the open surgical access. The aim of this study was to analyze thoracoscopic resection of lung metastases in children following CT-guided labeling with coil wires. We retrospectively analyzed data of children and adolescents undergoing this approach at our institution between 2010 and 2022 with regard to technical aspects as well as surgical and oncological data. Within this period, we performed this procedure on 12 patients wherein we resected 18 lesions (1–5 per patient). The median age of patients was 178 months (51–265). The median duration of coil wire placement was 41 min (30–173) and the median surgery time was 53 min (11–157). No conversions were necessary and no intraoperative complications occurred. Complete microscopic resection (R0) was achieved in all labeled lesions and malignant tumor components were found in 5/12 patients. Our study shows that with a careful patient selection, thoracoscopic resection of lung metastases after coil wire labeling is a safe and reproducible procedure in children. Using this approach, lesions that are expected to have a reduced intraoperative detectability during open surgery become resectable. Patients benefit from the minimally invasive surgical access and reduced operative trauma.

A hook wire dislodged into the subglottic area as a rare complication following computed tomography-guided hook wire localization: a case report

BACKGROUND

Computed tomography-guided hook wire localization (CT-GHWL) was used to localize the small pulmonary nodules before video-assisted thoracic surgery (VATS). Its associated complications included hook wire dislodgement, pulmonary hemorrhage, and pneumothorax. This is the first report of a patient with a hook wire sliding into the subglottic area after CT-GHWL.

CASE PRESENTATION

A 27-year-old female had productive cough for 8 days. A high-resolution CT scan showed a 12 mm part-solid nodule in the number 8 segment of the left lung. Prior to VATS, she received CT-GHWL to localize the nodule. During VATS, the hook wire unexpectedly slid away. A chest computed tomography was immediately performed and the sagittal reconstructed images showed the needle at the subglottic area. Finally, the needle was extracted by biopsy forceps under bronchoscope evaluation. The patient was eventually recovered and discharged.

CONCLUSIONS

Dislodge of the hook wire into the subglottic area is an extremely rare but serious complication following CT-GHWL. Attention should be paid to securing the needle on the lung surface during VATS.

A novel technique for preoperative localization of pulmonary nodules using a mixture of tissue adhesive and iohexol under computed tomography guidance: A 140 patient single-center study

Background

The increase in the incidence of pulmonary nodules has made computed tomography (CT) screening a requirement for diagnosis and treatment. Small pulmonary nodule detection during video‐assisted thoracoscopic surgery (VATS) or thoracotomy is frequently challenging; however, accurate and efficient localization of nodules is critical for precise resection. Herein, we introduce and evaluate the feasibility and safety of a novel technique for preoperative pulmonary nodule localization.

Methods

From March 2018 to December 2019, 140 patients with 153 pulmonary nodules measuring <2 cm in diameter were enrolled in this study. Preoperative, CT‐guided localization was performed on each nodule with an injected mixture of tissue adhesive and iohexol. Patient and nodule characteristics, localization data, complications, surgical data, and pathological results were analyzed.

Results

All 153 nodules in 140 patients were successfully marked preoperatively and detected during surgery (n = 153/153). Mean nodule size was 8.7 ± 2.6 mm, and mean distance from nodule to pleura was 7.9 ± 8.2 mm. The mean procedural time was 8.7 ± 1.0 min. Nine patients (6.4%) underwent two simultaneous nodule localizations and two patients (1.4%) underwent three simultaneous nodule localizations. Pneumothorax (17/140, 12.1%), pain (6/140, 4.3%), and pungent odor (5/140, 3.6%) were the major complications. No patient required further treatment, and no allergic reactions or embolisms were observed.

Conclusions

Preoperative CT‐guided nodule localization using a mixture of tissue adhesive and iohexol is an efficient technique for localizing small and impalpable pulmonary lesions, including multiple pulmonary nodules. Our study demonstrates that this novel method is safe and straightforward to implement.

Retrospective Review of Preoperative Wire Localization for Peripheral Ground Glass Opacities

Video-assisted thoracoscopy (VATS) is performed for diagnosis and treatment of peripheral lung nodules. Localization of peripherally located ground-glass opacities (GGOs) can be challenging. We report the results and usefulness of preoperative computed tomography (CT)-guided wire localization. Records for patients who underwent CT-guided wire localization prior to VATS resection for peripherally located GGOs were analyzed. Our technique for targeting the GGOs, complications, and histopathology of GGOs is reviewed. Forty patients (mean age 68 years) underwent pulmonary resections following CT-guided wire localization. The mean diameter of the GGO was 11.0 mm. The mean distance from the pleural surface to the peripheral margin of the GGO was 18.6 mm. Complications from the wire localization included pneumothorax in 5 patients (12.5%), none of whom required insertion of a chest tube; parenchymal hemorrhage in 3 patients (7.5%); and pleural effusion requiring chest tube drainage (unrelated to the wire) in 1 patient (2.5%). The mean operative time was 74 (range: 21-186 ) minutes. Pathological examination revealed lung malignancy in 36 patients (90%). The diagnostic yield was 100%. Preoperative CT-guided wire localization for solitary or multiple peripherally located GGOs allows for determination of histopathologic diagnosis and high diagnostic yield.