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Seitlinger J, Stasiak F, Streit A, Wollbrett C, Siat J, Schnedecker L, Gauchotte G, Renaud S. Assessment of needle-based confocal laser endomicroscopy (nCLE) as a tool for real-time diagnosis of non-small cell lung cancer. J Thorac Dis 2024; 16:4986-4993. [PMID: 39268137 PMCID: PMC11388227 DOI: 10.21037/jtd-24-546] [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: 04/02/2024] [Accepted: 06/28/2024] [Indexed: 09/15/2024]
Abstract
Background The widespread deployment of screening programs has increased the number of suspected pulmonary nodules diagnosed. The main objective of this retrospective study was to evaluate the concordance between needle-based confocal laser endomicroscopy (nCLE) image patterns and pathology reports. Methods In this retrospective study, we reviewed all cases of endobronchial navigational bronchoscopy (ENB) performed using the nCLE system as a guide for injecting a dye marker or for biopsy of a lung nodule. All surgeries were performed at the Thoracic Surgery Department, University Hospital Nancy, France, between June and October 2023. All navigation procedures were performed under general anesthesia by a senior resident supervised by a senior surgeon, and endobronchial positioning assistance was provided by using the nCLE probe. Results A total of 30 patients were included in this study. The median size of the suspicious lesions was 16 mm [interquartile range (IQR), 13 mm]. The average time the nCLE system was in contact with the lesion was 5 minutes (IQR, 5 minutes). In 22/30 patients, dark, enlarged pleomorphic cells were visualized, and for one patient, a mix of dark clusters and dark enlarged pleomorphic cells was visualized, leading to a diagnosis of cancer in 22/23 patients (95.6%). For five patients, dark clusters were visualized, resulting in a diagnosis of cancer in 100% of patients. Pathology was performed for 6/30 patients/21 (20%) by endobronchial biopsy and for 24 patients by surgical resection of the suspicious lesion (80%). Conclusions By retrospectively analyzing the nCLE lung cancer criteria published by Wijmans et al. in 2019, we observed 95.6% and 100% positive diagnoses according to the images visualized during the assistance of positioning. We believe that this type of technology could be used in the future for endobronchial analysis of suspected lesions and eventually for replacing frozen section analysis. However, the diagnostic value of this system needs to be confirmed, particularly for benign lesions.
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Affiliation(s)
- Joseph Seitlinger
- Thoracic Surgery Department, University Hospital Nancy, Nancy, France
- Research Unit Institut National de la Santé et de la Recherche Médicale U1256, Nancy, France
| | - Florent Stasiak
- Thoracic Surgery Department, University Hospital Nancy, Nancy, France
| | - Arthur Streit
- Thoracic Surgery Department, University Hospital Nancy, Nancy, France
| | | | - Joelle Siat
- Thoracic Surgery Department, University Hospital Nancy, Nancy, France
| | | | - Guillaume Gauchotte
- Research Unit Institut National de la Santé et de la Recherche Médicale U1256, Nancy, France
- Pathology Department, University Hospital Nancy, Nancy, France
| | - Stéphane Renaud
- Thoracic Surgery Department, University Hospital Nancy, Nancy, France
- Research Unit Institut National de la Santé et de la Recherche Médicale U1256, Nancy, France
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Romano G, Zirafa CC, Calabrò F, Alì G, Manca G, De Liperi A, Proietti A, Manfredini B, Di Stefano I, Marciano A, Davini F, Volterrani D, Melfi F. Sentinel Lymph Node Mapping in Lung Cancer: A Pilot Study for the Detection of Micrometastases in Stage I Non-Small Cell Lung Cancer. Tomography 2024; 10:761-772. [PMID: 38787018 PMCID: PMC11125324 DOI: 10.3390/tomography10050058] [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: 03/26/2024] [Revised: 05/06/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
Lymphadenectomy represents a fundamental step in the staging and treatment of non-small cell lung cancer (NSCLC). To date, the extension of lymphadenectomy in early-stage NSCLC is a debated topic due to its possible complications. The detection of sentinel lymph nodes (SLNs) is a strategy that can improve the selection of patients in which a more extended lymphadenectomy is necessary. This pilot study aimed to refine lymph nodal staging in early-stage NSCLC patients who underwent robotic lung resection through the application of innovative intraoperative sentinel lymph node (SLN) identification and the pathological evaluation using one-step nucleic acid amplification (OSNA). Clinical N0 NSCLC patients planning to undergo robotic lung resection were selected. The day before surgery, all patients underwent radionuclide computed tomography (CT)-guided marking of the primary lung lesion and subsequently Single Photon Emission Computed Tomography (SPECT) to identify tracer migration and, consequently, the area with higher radioactivity. On the day of surgery, the lymph nodal radioactivity was detected intraoperatively using a gamma camera. SLN was defined as the lymph node with the highest numerical value of radioactivity. The OSNA amplification, detecting the mRNA of CK19, was used for the detection of nodal metastases in the lymph nodes, including SLN. From March to July 2021, a total of 8 patients (3 female; 5 male), with a mean age of 66 years (range 48-77), were enrolled in the study. No complications relating to the CT-guided marking or preoperative SPECT were found. An average of 5.3 lymph nodal stations were examined (range 2-8). N2 positivity was found in 3 out of 8 patients (37.5%). Consequently, pathological examination of lymph nodes with OSNA resulted in three upstages from the clinical IB stage to pathological IIIA stage. Moreover, in 1 patient (18%) with nodal upstaging, a positive node was intraoperatively identified as SLN. Comparing this protocol to the usual practice, no difference was found in terms of the operating time, conversion rate, and complication rate. Our preliminary experience suggests that sentinel lymph node detection, in association with the accurate pathological staging of cN0 patients achieved using OSNA, is safe and effective in the identification of metastasis, which is usually undetected by standard diagnostic methods.
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Affiliation(s)
- Gaetano Romano
- Minimally Invasive and Robotic Thoracic Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, 56124 Pisa, Italy; (G.R.); (F.C.); (B.M.); (F.D.); (F.M.)
| | - Carmelina Cristina Zirafa
- Minimally Invasive and Robotic Thoracic Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, 56124 Pisa, Italy; (G.R.); (F.C.); (B.M.); (F.D.); (F.M.)
| | - Fabrizia Calabrò
- Minimally Invasive and Robotic Thoracic Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, 56124 Pisa, Italy; (G.R.); (F.C.); (B.M.); (F.D.); (F.M.)
| | - Greta Alì
- Pathological Anatomy, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (G.A.); (A.P.); (I.D.S.)
| | - Gianpiero Manca
- Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, 56124 Pisa, Italy; (G.M.); (A.M.); (D.V.)
| | - Annalisa De Liperi
- 2nd Radiology Unit, Department of Diagnostic Imaging, University Hospital of Pisa, 56124 Pisa, Italy;
| | - Agnese Proietti
- Pathological Anatomy, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (G.A.); (A.P.); (I.D.S.)
| | - Beatrice Manfredini
- Minimally Invasive and Robotic Thoracic Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, 56124 Pisa, Italy; (G.R.); (F.C.); (B.M.); (F.D.); (F.M.)
| | - Iosè Di Stefano
- Pathological Anatomy, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (G.A.); (A.P.); (I.D.S.)
| | - Andrea Marciano
- Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, 56124 Pisa, Italy; (G.M.); (A.M.); (D.V.)
| | - Federico Davini
- Minimally Invasive and Robotic Thoracic Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, 56124 Pisa, Italy; (G.R.); (F.C.); (B.M.); (F.D.); (F.M.)
| | - Duccio Volterrani
- Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, 56124 Pisa, Italy; (G.M.); (A.M.); (D.V.)
| | - Franca Melfi
- Minimally Invasive and Robotic Thoracic Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, 56124 Pisa, Italy; (G.R.); (F.C.); (B.M.); (F.D.); (F.M.)
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3
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Wollbrett C, Seitlinger J, Stasiak F, Piccoli J, Streit A, Siat J, Gauchotte G, Renaud S. Clinicopathological factors associated with sentinel lymph node detection in non-small-cell lung cancer. J Cardiothorac Surg 2024; 19:145. [PMID: 38504315 PMCID: PMC10949663 DOI: 10.1186/s13019-024-02632-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: 10/25/2023] [Accepted: 03/11/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Mapping of the pulmonary lymphatic system by near-infrared (NIR) fluorescence imaging might not always identify the first lymph node relay. The aim of this study was to determine the clinicopathologic factors allowing the identification of sentinel lymph nodes (SLNs) by NIR fluorescence imaging in thoracic surgery for non-small-cell lung cancer (NSCLC). METHODS We conducted a retrospective review of 92 patients treated for suspected or confirmed cN0 lung cancer with curative intent who underwent an intraoperative injection of indocyanine green (ICG) either by direct peritumoral injection or by endobronchial injection using electromagnetic navigational bronchoscopy (ENB). After exclusion of patients for technical failure, benign disease and metastasis, we analyzed the clinicopathologic findings of 65 patients treated for localized-stage NSCLC, comparing the group with identification of SLNs (SLN-positive group) with the group without identification of SLNs (SLN-negative group). RESULTS Forty-eight patients (73.8%) were SLN-positive. Patients with SLN positivity were more frequently female (50%) than the SLN-negative patients were (11.8%) (p = 0.006). The mean value of diffusing capacity for carbon monoxide (DLCO) was lower among the patients in the SLN-negative group (64.7% ± 16.7%) than the SLN-positive group (77.6% ± 17.2%, p < 0.01). The ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FCV) was higher in the SLN-positive group (69.0% vs. 60.8%, p = 0.02). Patients who were SLN-negative were characterized by a severe degree of emphysema (p = 0.003). There was no significant difference in pathologic characteristics. On univariate analyses, age, female sex, DLCO, FEV1/FVC, degree of emphysema, and tumor size were significantly associated with SLN detection. On multivariate analysis, DLCO > 75% (HR = 4.92, 95% CI: 1.27-24.7; p = 0.03) and female sex (HR = 5.55, 95% CI: 1.25-39.33; p = 0.04) were independently associated with SLN detection. CONCLUSIONS At a time of resurgence in the use of the sentinel lymph node mapping technique in the field of thoracic surgery, this study enabled us to identify, using multivariate analysis, two predictive factors for success: DLCO > 75% and female sex. Larger datasets are needed to confirm our results.
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Affiliation(s)
- Christophe Wollbrett
- Department of Thoracic Surgery, Nancy Regional University Hospital, Vandoeuvre-lès- Nancy, 54500, France
| | - Joseph Seitlinger
- Department of Thoracic Surgery, Nancy Regional University Hospital, Vandoeuvre-lès- Nancy, 54500, France
| | - Florent Stasiak
- Department of Thoracic Surgery, Nancy Regional University Hospital, Vandoeuvre-lès- Nancy, 54500, France
| | - Juliette Piccoli
- Department of Thoracic Surgery, Nancy Regional University Hospital, Vandoeuvre-lès- Nancy, 54500, France
| | - Arthur Streit
- Department of Thoracic Surgery, Nancy Regional University Hospital, Vandoeuvre-lès- Nancy, 54500, France
| | - Joelle Siat
- Department of Thoracic Surgery, Nancy Regional University Hospital, Vandoeuvre-lès- Nancy, 54500, France
| | - Guillaume Gauchotte
- Department of Pathology and Molecular Biology, Nancy Regional University Hospital, Vandoeuvre-lès-Nancy, 54500, France
- Research Unit INSERM U1256, NGERE Unit, Lorraine University, Vandoeuvre-lès-Nancy, 54500, France
| | - Stéphane Renaud
- Department of Thoracic Surgery, Nancy Regional University Hospital, Vandoeuvre-lès- Nancy, 54500, France.
- Research Unit INSERM U1256, NGERE Unit, Lorraine University, Vandoeuvre-lès-Nancy, 54500, France.
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Huang ZN, He QC, Qiu WW, Wu J, Zheng CY, Lin GS, Li P, Wang JB, Lin JX, Lu J, Cao LL, Lin M, Tu RH, Zheng CH, Chen QY, Huang CM, Xie JW. OSATS scoring confirms ICG enhancement of performance in laparoscopic radical gastrectomy: a post-hoc analysis of a randomized controlled trial. Int J Surg 2024; 110:342-352. [PMID: 37939147 PMCID: PMC10793768 DOI: 10.1097/js9.0000000000000830] [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: 06/13/2023] [Accepted: 09/28/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Indocyanine green (ICG) fluorescence imaging is effective in increasing the number of lymph node dissections during laparoscopic radical gastrectomy; however, no studies have attempted to explain this phenomenon. METHODS This study utilized the data from a previous randomized controlled trial (FUGES-012 study) investigating ICG-guided laparoscopic radical gastrectomy performed between November 2018 and July 2019. The Objective Structured Assessments of Technical Skills (OSATS) scoring system was used to grade videos from the ICG and non-ICG groups. Patients with an OSATS score greater than 29 were classified as the high-OSATS population, while those with an OSATS score less than or equal to 29 were classified as the low-OSATS population. RESULTS A total of 258 patients were included in the modified intention-to-treat analysis: 129 in the ICG group and 129 in the non-ICG group. The OSATS score of the ICG group was higher than that of the non-ICG group (29.6±2.6 vs. 26.6±3.6; P <0.001). The ICG group underwent a significantly higher mean total number of lymph node dissections than the non-ICG group (50.5±15.9 vs. 42.0±10.3; adjusted P <0.001). The group assigned to ICG use, better OSATS (high-OSATS) scores were observed, which correlated with greater D2 lymph node retrieval (54.1±15.0 vs. 47.2±8.7; adjusted P =0.039). Finally, the ICG group had a lower rate of lymph node noncompliance than that of the non-ICG group (31.8 vs. 57.4%; P <0.001). CONCLUSIONS By applying the ICG fluorescence navigation technique, better OSATS scores were observed, which correlated with greater lymph node retrieval and a lower lymph node noncompliance rate, as recommended for individualized laparoscopic radical gastrectomy.
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Affiliation(s)
- Ze-Ning Huang
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Qi-Chen He
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Wen-Wu Qiu
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Ju Wu
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
- Department of General Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian
| | - Chang-Yue Zheng
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
- Department of Gastrointestinal Surgery, the Affiliated Hospital of Putian University, Putian, People’s Republic of China
| | - Guo-Sheng Lin
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Ping Li
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Jia-Bin Wang
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Jian-Xian Lin
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Jun Lu
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Long-Long Cao
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Mi Lin
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Ru-Hong Tu
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Chao-Hui Zheng
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Qi-Yue Chen
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Chang-Ming Huang
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Jian-Wei Xie
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
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Forcada C, Gómez-Hernández MT, Fuentes MG, Rivas CE, Jiménez MF. Assessment of Feasibility and Prognostic Value of Sentinel Lymph Node Identification by Near-Infrared Fluorescence in Non-Small Cell Lung Cancer in Patients Undergoing Robotic Anatomic Lung Resections. OPEN RESPIRATORY ARCHIVES 2023; 5:100273. [PMID: 37818450 PMCID: PMC10560828 DOI: 10.1016/j.opresp.2023.100273] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023] Open
Affiliation(s)
- Clara Forcada
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - María Teresa Gómez-Hernández
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
- Salamanca Institute of Biomedical Research, Salamanca, Spain
- University of Salamanca, Salamanca, Spain
| | - Marta G. Fuentes
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
- Salamanca Institute of Biomedical Research, Salamanca, Spain
- University of Salamanca, Salamanca, Spain
| | - Cristina E. Rivas
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
- Salamanca Institute of Biomedical Research, Salamanca, Spain
| | - Marcelo F. Jiménez
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
- Salamanca Institute of Biomedical Research, Salamanca, Spain
- University of Salamanca, Salamanca, Spain
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Voulaz E, Giudici VM, Lanza E, Bottoni E, Cariboni U, Crepaldi A, Ferrillo G, Marulli G, Alloisio M, Mangiameli G, Testori A. Percutaneous Computed Tomography (CT)-Guided Localization with Indocyanine Green for the Thoracoscopic Resection of Small Pulmonary Nodules. J Clin Med 2023; 12:6149. [PMID: 37834792 PMCID: PMC10573235 DOI: 10.3390/jcm12196149] [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: 05/25/2023] [Revised: 09/07/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND The identification of small lung nodules is challenging during mini-invasive thoracic surgery. Unable to palpate them directly, surgeons have developed several methods to preoperatively localize pulmonary nodules, including the computed tomography-guided positioning of coils or metallic landmarks (hook wire) or bronchoscopic marking. METHODS We present a series of patients scheduled for the video-assisted thoracoscopic sublobar resection of small pulmonary nodules, in which we performed preoperative percutaneous computed tomography (CT)-guided nodule localization through the injection of a mixture of indocyanine green and human albumin. RESULTS A total of 40 patients underwent a preoperative CT-guided injection of indocyanine green followed by VATS resection within 24 h. Patients tolerated the procedure well, no pain medication was administrated, and no complications were observed during the marking procedure. All pulmonary nodules were easily detected and successfully resected. CONCLUSION the near-infrared dye marking solution of indocyanine green (ICG) with diluted human albumin was safe, effective, and easy to perform. The ICG solution has the potential to facilitate the accurate localization and resection of pulmonary nodules during VATS surgery, avoiding the risk of marker displacement/migration.
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Affiliation(s)
- Emanuele Voulaz
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56 Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4 Pieve Emanuele, 20090 Milan, Italy
| | - Veronica Maria Giudici
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56 Rozzano, 20089 Milan, Italy
| | - Ezio Lanza
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4 Pieve Emanuele, 20090 Milan, Italy
- Department of Diagnostic and Interventional Radiology, IRCCS Humanitas Research Hospital, Via Manzoni 56 Rozzano, 20089 Milan, Italy
| | - Edoardo Bottoni
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56 Rozzano, 20089 Milan, Italy
| | - Umberto Cariboni
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56 Rozzano, 20089 Milan, Italy
| | - Alessandro Crepaldi
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56 Rozzano, 20089 Milan, Italy
| | - Giuseppe Ferrillo
- Department of Diagnostic and Interventional Radiology, IRCCS Humanitas Research Hospital, Via Manzoni 56 Rozzano, 20089 Milan, Italy
| | - Giuseppe Marulli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56 Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4 Pieve Emanuele, 20090 Milan, Italy
| | - Marco Alloisio
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56 Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4 Pieve Emanuele, 20090 Milan, Italy
| | - Giuseppe Mangiameli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56 Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4 Pieve Emanuele, 20090 Milan, Italy
| | - Alberto Testori
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56 Rozzano, 20089 Milan, Italy
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