Advances in Image-Guided Thoracic Surgery.

Different modalities of surgical excisional biopsy can be used when needle biopsy fails to provide tissue diagnosis. These modalities include intraoperative localization techniques, such as ultrasonography, and preoperative localization techniques, such as liquid dyes, radiolabeled aggregates, hook wires, microcoils, and navigational bronchoscopy techniques. The highest level of evidence for efficacy currently appears to support microcoils, radiolabeling, and hook-wire localization techniques. Multiple methods have been used to help identify intersegmental planes to facilitate minimally invasive segmental resection. These methods include use of 3-dimensional multidetector computed tomographic rendering, administration of dyes such as indocyanine green, and virtual bronchoscopic techniques.