Sébastien Bommart1, Arnaud Bourdin2, Grégory Marin3, Jean Philippe Berthet4, Jean Louis Pujol5, Isabelle Serre6, Nicolas Molinari3, Charles Marty-Ané7, Hélène Kovacsik8. 1. Department of Radiology, CHU Montpellier, Montpellier, France; INSERM U 1046, Université Montpellier, Montpellier, France. Electronic address: s-bommart@chu-montpellier.fr. 2. Department of Respiratory Disease, CHU Montpellier, Montpellier, France; INSERM U 1046, Université Montpellier, Montpellier, France. 3. Department of Statistics, CHU Montpellier, Montpellier, France. 4. Department of Thoracic Surgery, CHU Montpellier, Montpellier, France; INSERM U 1046, Université Montpellier, Montpellier, France. 5. Department of Respiratory Disease, CHU Montpellier, Montpellier, France. 6. Department of Pathology, CHU Montpellier, Montpellier, France. 7. Department of Thoracic Surgery, CHU Montpellier, Montpellier, France. 8. Department of Radiology, CHU Montpellier, Montpellier, France.
Abstract
BACKGROUND: The management of occult lung lesions, particularly subsolid opacities, is a new challenge because they are difficult to localize during surgery and the number of lesions detected by computed tomography (CT) is increasing. METHODS: Between February 2008 and December 2011, preoperative CT-guided marking with coils was systematically carried out to localize presumed impalpable nodules before video-assisted thoracoscopic surgery (VATS). The procedure feasibility, reliability, and safety as well as its impact on the resection volume and on the pathologic examination strategy were examined. RESULTS: This preoperative marking procedure was used for 68 nodules in 60 consecutive patients. The mean procedural time was 25 minutes/patient and complications included minimal asymptomatic pneumothorax (42 cases, 70%) and hemorrhagic suffusion (21 patients, 35%). Patients with non-retrieved coils during VATS required larger resection volumes (94.88 mm3 vs 20.65 mm3; p=0.008). The presence of a coil loop in the pleural space was not statistically associated with higher resected lung volume. Primary pulmonary adenocarcinoma was found in 42 patients (71.2%). Five nodules were associated with atypical adenomatous hyperplasia. Pathologic examination was considered to be improved by the presence of a coil next to the lesion but not within it. Coil placement modified the pathology practices for intraoperative analysis, as tissue sampling in the immediate vicinity of the coil was preferred to systematic sampling. CONCLUSIONS: Impalpable lung nodules can be safely marked with coils preoperatively to improve their surgical and pathologic management.
BACKGROUND: The management of occult lung lesions, particularly subsolid opacities, is a new challenge because they are difficult to localize during surgery and the number of lesions detected by computed tomography (CT) is increasing. METHODS: Between February 2008 and December 2011, preoperative CT-guided marking with coils was systematically carried out to localize presumed impalpable nodules before video-assisted thoracoscopic surgery (VATS). The procedure feasibility, reliability, and safety as well as its impact on the resection volume and on the pathologic examination strategy were examined. RESULTS: This preoperative marking procedure was used for 68 nodules in 60 consecutive patients. The mean procedural time was 25 minutes/patient and complications included minimal asymptomatic pneumothorax (42 cases, 70%) and hemorrhagic suffusion (21 patients, 35%). Patients with non-retrieved coils during VATS required larger resection volumes (94.88 mm3 vs 20.65 mm3; p=0.008). The presence of a coil loop in the pleural space was not statistically associated with higher resected lung volume. Primary pulmonary adenocarcinoma was found in 42 patients (71.2%). Five nodules were associated with atypical adenomatous hyperplasia. Pathologic examination was considered to be improved by the presence of a coil next to the lesion but not within it. Coil placement modified the pathology practices for intraoperative analysis, as tissue sampling in the immediate vicinity of the coil was preferred to systematic sampling. CONCLUSIONS: Impalpable lung nodules can be safely marked with coils preoperatively to improve their surgical and pathologic management.
Authors: Laura L Donahoe; Elsie T Nguyen; Tae-Bong Chung; Lan-Chau Kha; Marcelo Cypel; Gail E Darling; Marc de Perrot; Shaf Keshavjee; Andrew F Pierre; Thomas K Waddell; Kazuhiro Yasufuku Journal: J Thorac Dis Date: 2016-08 Impact factor: 2.895