DOI QR코드

DOI QR Code

CT-Guided Microcoil Localization of Small Peripheral Pulmonary Nodules to Direct Video-Assisted Thoracoscopic Resection without the Aid of Intraoperative Fluoroscopy

  • Zhen-guo Huang (Department of Radiology, China-Japan Friendship Hospital) ;
  • Cun-li Wang (Department of Radiology, Baotou Third Hospital) ;
  • Hong-liang Sun (Department of Radiology, China-Japan Friendship Hospital) ;
  • Chuan-dong Li (Department of Radiology, China-Japan Friendship Hospital) ;
  • Bao-xiang Gao (Department of Radiology, China-Japan Friendship Hospital) ;
  • He Chen (Department of Radiology, China-Japan Friendship Hospital) ;
  • Min-xing Yang (Department of Radiology, China-Japan Friendship Hospital)
  • Received : 2020.04.13
  • Accepted : 2020.12.01
  • Published : 2021.07.01

Abstract

Objective: To evaluate the feasibility, safety, and effectiveness of CT-guided microcoil localization of solitary pulmonary nodules (SPNs) for guiding video-assisted thoracoscopic surgery (VATS). Materials and Methods: Between June 2016 and October 2019, 454 consecutive patients with 501 SPNs who received CT-guided microcoil localization before VATS in our institution were enrolled. The diameter of the nodules was 0.93 ± 0.49 cm, and the shortest distance from the nodules to the pleura was 1.41 ± 0.95 cm. The distal end of the microcoil was placed less than 1 cm away from the nodule, and the proximal end was placed outside the visceral pleura. VATS was performed under the guidance of implanted microcoils without the aid of intraoperative fluoroscopy. Results: All 501 nodules were marked with microcoils. The time required for microcoil localization was 12.8 ± 5.2 minutes. Microcoil localization-related complications occurred in 179 cases (39.4%). None of the complications required treatment. A total of 463 nodules were successfully resected under the guidance of implanted microcoils. VATS revealed 38 patients with dislocated microcoils, of which 28 underwent wedge resection (21 cases under the guidance of the bleeding points of pleural puncture, 7 cases through palpation), 5 underwent direct lobectomy, and the remaining 5 underwent a conversion to thoracotomy. In 4 cases, a portion of the microcoil remained in the lung parenchyma. Conclusion: CT-guided microcoil localization of SPNs is safe and reliable. Marking the nodule and pleura simultaneously with microcoils can effectively guide the resection of SPNs using VATS without the aid of intraoperative fluoroscopy.

Keywords

References

  1. Burdine J, Joyce LD, Plunkett MB, Inampudi S, Kaye MG, Dunn DH. Feasibility and value of video-assisted thoracoscopic surgery wedge excision of small pulmonary nodules in patients with malignancy. Chest 2002;122:1467-1470 https://doi.org/10.1378/chest.122.4.1467
  2. Suzuki K, Nagai K, Yoshida J, Ohmatsu H, Takahashi K, Nishimura M, et al. Video-assisted thoracoscopic surgery for small indeterminate pulmonary nodules: indications for preoperative marking. Chest 1999;115:563-568 https://doi.org/10.1378/chest.115.2.563
  3. Wang ZX, Li L, Zhang Z, Wang GH, Kong DM, Wang XD, et al. High-resolution computed tomography features and CT-guided microcoil localization of subcentimeter pulmonary ground-glass opacities: radiological processing prior to video-assisted thoracoscopic surgery. J Thorac Dis 2018;10:2676-2684 https://doi.org/10.21037/jtd.2018.04.87
  4. Mayo JR, Clifton JC, Powell TI, English JC, Evans KG, Yee J, et al. Lung nodules: CT-guided placement of microcoils to direct video-assisted thoracoscopic surgical resection. Radiology 2009;250:576-585 https://doi.org/10.1148/radiol.2502080442
  5. Liu L, Zhang LJ, Chen B, Cao JM, Lu GM, Yuan L, et al. Novel CT-guided coil localization of peripheral pulmonary nodules prior to video-assisted thoracoscopic surgery: a pilot study. Acta Radiol 2014;55:699-706 https://doi.org/10.1177/0284185113506136
  6. Su TH, Fan YF, Jin L, He W, Hu LB. CT-guided localization of small pulmonary nodules using adjacent microcoil implantation prior to video-assisted thoracoscopic surgical resection. Eur Radiol 2015;25:2627-2633 https://doi.org/10.1007/s00330-015-3676-5
  7. Kha LC, Hanneman K, Donahoe L, Chung T, Pierre AF, Yasufuku K, et al. Safety and efficacy of modified preoperative lung nodule microcoil localization without pleural marking: a pilot study. J Thorac Imaging 2016;31:15-22 https://doi.org/10.1097/RTI.0000000000000188
  8. Donahoe LL, Nguyen ET, Chung TB, Kha LC, Cypel M, Darling GE, et al. CT-guided microcoil VATS resection of lung nodules: a single-centre experience and review of the literature. J Thorac Dis 2016;8:1986-1994 https://doi.org/10.21037/jtd.2016.06.74
  9. Lempel JK, Raymond DP, Ahmad U, O'Malley S, Bolen MA, Graham R, et al. Video-assisted thoracic surgery resection without intraoperative fluoroscopy after CT-guided microcoil localization of peripheral pulmonary nodules. J Vasc Interv Radiol 2018;29:1423-1428 https://doi.org/10.1016/j.jvir.2018.01.787
  10. Powell TI, Jangra D, Clifton JC, Lara-Guerra H, Church N, English J, et al. Peripheral lung nodules: fluoroscopically guided video-assisted thoracoscopic resection after computed tomography-guided localization using platinum microcoils. Ann Surg 2004;240:481-488 https://doi.org/10.1097/01.sla.0000137132.01881.57
  11. Tseng YH, Lee YF, Hsieh MS, Chien N, Ko WC, Chen JY, et al. Preoperative computed tomography-guided dye injection to localize multiple lung nodules for video-assisted thoracoscopic surgery. J Thorac Dis 2016;8:S666-S671 https://doi.org/10.21037/jtd.2016.09.46
  12. Miura H, Yamagami T, Tanaka O, Yoshimatsu R, Ichijo Y, Kato D, et al. CT findings after lipiodol marking performed before video-assisted thoracoscopic surgery for small pulmonary nodules. Acta Radiol 2016;57:303-310 https://doi.org/10.1177/0284185115576047
  13. Lee NK, Park CM, Kang CH, Jeon YK, Choo JY, Lee HJ, et al. CT-guided percutaneous transthoracic localization of pulmonary nodules prior to video-assisted thoracoscopic surgery using barium suspension. Korean J Radiol 2012;13:694-701 https://doi.org/10.3348/kjr.2012.13.6.694
  14. Nardini M, Bilancia R, Paul I, Jayakumar S, Papoulidis P, ElSaegh M, et al. 99mTechnetium and methylene blue guided pulmonary nodules resections: preliminary British experience. J Thorac Dis 2018;10:1015-1021 https://doi.org/10.21037/jtd.2018.01.143
  15. Rodrigues JCL, Pierre AF, Hanneman K, Cabanero M, Kavanagh J, Waddell TK, et al. CT-guided microcoil pulmonary nodule localization prior to video-assisted thoracoscopic surgery: diagnostic utility and recurrence-free survival. Radiology 2019;291:214-222 https://doi.org/10.1148/radiol.2019181674
  16. Pang X, Xue L, Chen J, Ding J. A novel hybrid technique for localization of subcentimeter lung nodules. J Thorac Dis 2017;9:1107-1112 https://doi.org/10.21037/jtd.2017.03.75
  17. Sui X, Zhao H, Yang F, Li JL, Wang J. Computed tomography guided microcoil localization for pulmonary small nodules and ground-glass opacity prior to thoracoscopic resection. J Thorac Dis 2015;7:1580-1587
  18. Li C, Liu B, Jia H, Dong Z, Meng H. Computed tomography-guided hook wire localization facilitates video-assisted thoracoscopic surgery of pulmonary ground-glass nodules. Thorac Cancer 2018;9:1145-1150 https://doi.org/10.1111/1759-7714.12801
  19. Tao G, Jingying Y, Tan G, Xiaotao D, Min C. A novel CT-guided technique using medical adhesive for localization of small pulmonary ground-glass nodules and mixed ground-glass nodules (≤20 mm) before video-assisted thoracoscopic surgery. Diagn Interv Radiol 2018;24:209-212 https://doi.org/10.5152/dir.2018.17315
  20. Hwang S, Kim TG, Song YG. Comparison of hook wire versus coil localization for video-assisted thoracoscopic surgery. Thorac Cancer 2018;9:384-389 https://doi.org/10.1111/1759-7714.12589
  21. Hu L, Gao J, Chen C, Zhi X, Liu H, Hong N. Comparison between the application of microcoil and hookwire for localizing pulmonary nodules. Eur Radiol 2019;29:4036-4043 https://doi.org/10.1007/s00330-018-5939-4