Thorac Cardiovasc Surg 2020; 68(06): 525-532
DOI: 10.1055/s-0039-3400999
Original Thoracic

Preoperative Computed Tomography-Guided Localization for Pulmonary Nodules with Glue and Dye

Tian Jiang*
1   Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
,
Miao Lin*
1   Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
,
Mengnan Zhao
1   Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
,
Cheng Zhan
1   Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
,
Ming Li
1   Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
,
Mingxiang Feng
1   Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
,
Qun Wang
1   Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
› Author Affiliations
Funding This work was supported by the National Natural Science Foundation of China (Grant No. 81672268).

Abstract

Background This study was aimed to describe a new localization technique developed using medical glue and methylene blue dye, and characterized the localization results and postoperative outcome to evaluate its safety and usefulness.

Methods This retrospective study was conducted at our center from January 2016 to April 2018. Totally 346 consecutive patients with 383 nodules who underwent preoperative computed tomography (CT)-guided medical glue and methylene blue dye localization, followed by lung resection, were enrolled in this study.

Results Mean nodule size was 7.7 ± 3.7 mm (range: 2–30 mm), with a mean depth from pleura or fissure of 9.4 ± 9.3 mm (range: 0–60 mm). The success rate of CT-guided localization for pulmonary nodules was 99.5% (381/383) of the nodules. Localization-related complications included mild pneumothorax in 16 (4.6%) patients, mild hemothorax in 7 (2.0%) patients, and hemoptysis in 1 (0.3%) patient. Pleural reaction occurred in 7 (2.0%) and pain in 25 (7.2%) patients. All 383 nodules were resected successfully, with conversion to thoracotomy only required in two patients for adhesion and calcification of lymph nodes. All patients recovered well postoperatively, with a short postoperative hospital stay (3.7 ± 2.0 days) and a low complication rate (2.6%, 9/346).

Conclusion CT-guided medical glue and methylene blue dye localization prior to video-assisted thoracoscopic surgery (VATS) lung resection was a novel, safe, and technically feasible method, with a high-technical success rate and a low-complication rate. It allowed surgeons to easily locate and detect the nodules and estimate the surgical margin.

Authors' Contribution

Tian Jiang: study design, analysis and interpretation of data, drafting the article, and final approval.


Miao Lin: study design, analysis and interpretation of data, drafting the article, and final approval.


Mengnan Zhao: interpretation of data, drafting the article, and final approval.


Ming Li: analysis and interpretation of data, drafting the article, and final approval.


Cheng Zhan: acquisition of data, drafting the article, and final approval.


Mingxiang Feng: study design, acquisition of data, drafting the article, revising the article critically for important intellectual content, and final approval.


Qun Wang: study design, drafting the article, revising the article critically for important intellectual content, and final approval.


* Authors Tian Jiang and Miao Lin contributed equally to this work.




Publication History

Received: 07 March 2019

Accepted: 28 October 2019

Article published online:
01 March 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Stuttgart · New York

 
  • References

  • 1 Wood DE, Kazerooni EA, Baum SL. , et al. Lung cancer screening, version 3.2018, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 2018; 16 (04) 412-441
  • 2 Aberle DR, Adams AM, Berg CD. , et al; National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011; 365 (05) 395-409
  • 3 Bhatt KM, Tandon YK, Graham R. , et al. Electromagnetic navigational bronchoscopy versus CT-guided percutaneous sampling of peripheral indeterminate pulmonary nodules: a cohort study. Radiology 2018; 286 (03) 1052-1061
  • 4 Oki M, Saka H, Asano F. , et al. Use of an ultrathin vs thin bronchoscope for peripheral pulmonary lesions: a randomized trial. Chest 2019; 156 (05) 954-964
  • 5 Shimizu K, Ikeda N, Tsuboi M, Hirano T, Kato H. Percutaneous CT-guided fine needle aspiration for lung cancer smaller than 2 cm and revealed by ground-glass opacity at CT. Lung Cancer 2006; 51 (02) 173-179
  • 6 Howington JA, Gunnarsson CL, Maddaus MA. , et al. In-hospital clinical and economic consequences of pulmonary wedge resections for cancer using video-assisted thoracoscopic techniques vs traditional open resections: a retrospective database analysis. Chest 2012; 141 (02) 429-435
  • 7 Khereba M, Ferraro P, Duranceau A. , et al. Thoracoscopic localization of intraparenchymal pulmonary nodules using direct intracavitary thoracoscopic ultrasonography prevents conversion of VATS procedures to thoracotomy in selected patients. J Thorac Cardiovasc Surg 2012; 144 (05) 1160-1165
  • 8 Thistlethwaite PA, Gower JR, Hernandez M, Zhang Y, Picel AC, Roberts AC. Needle localization of small pulmonary nodules: lessons learned. J Thorac Cardiovasc Surg 2018; 155 (05) 2140-2147
  • 9 Hanauer M, Perentes JY, Krueger T. , et al. Pre-operative localization of solitary pulmonary nodules with computed tomography-guided hook wire: report of 181 patients. J Cardiothorac Surg 2016; 11: 5
  • 10 Ichinose J, Kohno T, Fujimori S, Harano T, Suzuki S. Efficacy and complications of computed tomography-guided hook wire localization. Ann Thorac Surg 2013; 96 (04) 1203-1208
  • 11 Xu X, Yao Y, Shen Y, Zhang P, Zhou J. Clinical analysis of percutaneous computed tomography-guided hook wire localization of 168 small pulmonary nodules. Ann Thorac Surg 2015; 100 (05) 1861-1867
  • 12 Finley RJ, Mayo JR, Grant K. , et al. Preoperative computed tomography-guided microcoil localization of small peripheral pulmonary nodules: a prospective randomized controlled trial. J Thorac Cardiovasc Surg 2015; 149 (01) 26-31
  • 13 Moon SW, Cho DG, Cho KD, Kang CU, Jo MS, Park HJ. Fluoroscopy-assisted thoracoscopic resection for small intrapulmonary lesions after preoperative computed tomography-guided localization using fragmented platinum microcoils. Thorac Cardiovasc Surg 2012; 60 (06) 413-418
  • 14 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 (09) 1580-1587
  • 15 Watanabe K, Nomori H, Ohtsuka T, Kaji M, Naruke T, Suemasu K. Usefulness and complications of computed tomography-guided lipiodol marking for fluoroscopy-assisted thoracoscopic resection of small pulmonary nodules: experience with 174 nodules. J Thorac Cardiovasc Surg 2006; 132 (02) 320-324
  • 16 McConnell PI, Feola GP, Meyers RL. Methylene blue-stained autologous blood for needle localization and thoracoscopic resection of deep pulmonary nodules. J Pediatr Surg 2002; 37 (12) 1729-1731
  • 17 Wicky S, Mayor B, Cuttat JF, Schnyder P. CT-guided localizations of pulmonary nodules with methylene blue injections for thoracoscopic resections. Chest 1994; 106 (05) 1326-1328
  • 18 Lenglinger FX, Schwarz CD, Artmann W. Localization of pulmonary nodules before thoracoscopic surgery: value of percutaneous staining with methylene blue. Am J Roentgenol 1994; 163 (02) 297-300
  • 19 Lin MW, Tseng YH, Lee YF. , et al. Computed tomography-guided patent blue vital dye localization of pulmonary nodules in uniportal thoracoscopy. J Thorac Cardiovasc Surg 2016; 152 (02) 535-544
  • 20 Tseng YH, Lee YF, Hsieh MS. , et al. Preoperative computed tomography-guided dye injection to localize multiple lung nodules for video-assisted thoracoscopic surgery. J Thorac Dis 2016; 8 (Suppl. 09) S666-S671
  • 21 Muñoz-Largacha JA, Ebright MI, Litle VR, Fernando HC. Electromagnetic navigational bronchoscopy with dye marking for identification of small peripheral lung nodules during minimally invasive surgical resection. J Thorac Dis 2017; 9 (03) 802-808
  • 22 Marino KA, Sullivan JL, Weksler B. Electromagnetic navigation bronchoscopy for identifying lung nodules for thoracoscopic resection. Ann Thorac Surg 2016; 102 (02) 454-457
  • 23 Ambrogi MC, Melfi F, Zirafa C. , et al. Radio-guided thoracoscopic surgery (RGTS) of small pulmonary nodules. Surg Endosc 2012; 26 (04) 914-919
  • 24 Bellomi M, Veronesi G, Trifirò G. , et al. Computed tomography-guided preoperative radiotracer localization of nonpalpable lung nodules. Ann Thorac Surg 2010; 90 (06) 1759-1764
  • 25 Andrade RS. Electromagnetic navigation bronchoscopy-guided thoracoscopic wedge resection of small pulmonary nodules. Semin Thorac Cardiovasc Surg 2010; 22 (03) 262-265
  • 26 Saito H, Minamiya Y, Matsuzaki I. , et al. Indication for preoperative localization of small peripheral pulmonary nodules in thoracoscopic surgery. J Thorac Cardiovasc Surg 2002; 124 (06) 1198-1202
  • 27 Bertolaccini L, Terzi A, Spada E, Acchiardi F, Ghirardo D. Not palpable? Role of radio-guided video-assisted thoracic surgery for nonpalpable solitary pulmonary nodules. Gen Thorac Cardiovasc Surg 2012; 60 (05) 280-284
  • 28 Nakashima S, Watanabe A, Obama T, Yamada G, Takahashi H, Higami T. Need for preoperative computed tomography-guided localization in video-assisted thoracoscopic surgery pulmonary resections of metastatic pulmonary nodules. Ann Thorac Surg 2010; 89 (01) 212-218
  • 29 MacMahon H, Naidich DP, Goo JM. , et al. Guidelines for management of incidental pulmonary nodules detected on CT images: from the Fleischner Society 2017. Radiology 2017; 284 (01) 228-243
  • 30 Brunelli A, Cassivi SD, Halgren L. Risk factors for prolonged air leak after pulmonary resection. Thorac Surg Clin 2010; 20 (03) 359-364
  • 31 Singhal S, Ferraris VA, Bridges CR. , et al. Management of alveolar air leaks after pulmonary resection. Ann Thorac Surg 2010; 89 (04) 1327-1335
  • 32 Shen Y, Liu Y, Feng M. , et al. Uniportal video-assisted thoracoscopic lobectomy: Zhongshan experience. J Vis Surg 2015; 1: 5
  • 33 Ettinger DS, Wood DE, Akerley W. , et al. NCCN guidelines insights: non-small cell lung cancer, version 4.2016. J Natl Compr Canc Netw 2016; 14 (03) 255-264