T Gruber-Rouh1, N N N Naguib2, M Beeres3, P Kleine4, T J Vogl3, V Jacobi3, M Alsubhi3, N A Nour-Eldin5. 1. Institute for Diagnostic and Interventional Radiology, University Hospital, Theodor-Stern-Kai St.7, 60590 Frankfurt am Main, Germany. Electronic address: tgruberrouh@googlemail.com. 2. Institute for Diagnostic and Interventional Radiology, University Hospital, Theodor-Stern-Kai St.7, 60590 Frankfurt am Main, Germany; Department of Diagnostic and Interventional Radiology, Alexandria University Hospital, Alexandria, Egypt. 3. Institute for Diagnostic and Interventional Radiology, University Hospital, Theodor-Stern-Kai St.7, 60590 Frankfurt am Main, Germany. 4. Department of Cardiothoracic Surgery, University Hospital, Theodor-Stern-Kai St.7, 60590 Frankfurt am Main, Germany. 5. Institute for Diagnostic and Interventional Radiology, University Hospital, Theodor-Stern-Kai St.7, 60590 Frankfurt am Main, Germany; Department of Diagnostic and Interventional Radiology, Cairo University Hospital, Cairo, Egypt.
Abstract
AIM: To assess the feasibility, safety, and efficacy of computed tomography (CT)-guided pulmonary nodule localisation using a hooked guide wire before video-assisted thoracoscopic surgery (VATS). MATERIALS AND METHODS: The study included 79 patients with a history of malignancies outside the lung associated with pulmonary nodules. Mean lesion size was 0.7 cm (range 0.5-1.8 cm) and the mean lesion distance to the pleural surface was 1.5 cm (range 0.2-5 cm). All lesions (n=82) were marked with a 22-G hook wire. The technique was designed to insert the tip of the hook wire within or maximally 1 cm from the edge of the lesion. The Mann-Whitney U-test was used for univariate analyses and Fisher's exact test for categorical values. RESULTS: The hooked guide wire was positioned successfully in all 82 pulmonary nodules within mean time of 9 minutes (8-20 minutes, SD: 2.5 minutes). The procedure time was inversely proportional to the size of the lesion (Spearman correlation factor 0.7). Minimal pneumothoraces were observed in five patients (7.6%). Pneumothorax was not correlated to the histopathology of the pulmonary nodules (p>0.09). Focal perilesional pulmonary haemorrhage developed in four patients (5%). Both haemorrhage and pneumothorax were significantly correlated to lesions <10 mm (p=0.02 and 0.01 respectively). The volume of resected lung tissue was significantly correlated to lesions of increased distance from the pleural surface ≥2.5 cm in comparison to lesions of <2.5 cm from the pleural surface. CONCLUSION: CT-guided pulmonary nodule localisation prior to VATS could enable safe, accurate surgical guidance for the localisation of small pulmonary nodules.
AIM: To assess the feasibility, safety, and efficacy of computed tomography (CT)-guided pulmonary nodule localisation using a hooked guide wire before video-assisted thoracoscopic surgery (VATS). MATERIALS AND METHODS: The study included 79 patients with a history of malignancies outside the lung associated with pulmonary nodules. Mean lesion size was 0.7 cm (range 0.5-1.8 cm) and the mean lesion distance to the pleural surface was 1.5 cm (range 0.2-5 cm). All lesions (n=82) were marked with a 22-G hook wire. The technique was designed to insert the tip of the hook wire within or maximally 1 cm from the edge of the lesion. The Mann-Whitney U-test was used for univariate analyses and Fisher's exact test for categorical values. RESULTS: The hooked guide wire was positioned successfully in all 82 pulmonary nodules within mean time of 9 minutes (8-20 minutes, SD: 2.5 minutes). The procedure time was inversely proportional to the size of the lesion (Spearman correlation factor 0.7). Minimal pneumothoraces were observed in five patients (7.6%). Pneumothorax was not correlated to the histopathology of the pulmonary nodules (p>0.09). Focal perilesional pulmonary haemorrhage developed in four patients (5%). Both haemorrhage and pneumothorax were significantly correlated to lesions <10 mm (p=0.02 and 0.01 respectively). The volume of resected lung tissue was significantly correlated to lesions of increased distance from the pleural surface ≥2.5 cm in comparison to lesions of <2.5 cm from the pleural surface. CONCLUSION: CT-guided pulmonary nodule localisation prior to VATS could enable safe, accurate surgical guidance for the localisation of small pulmonary nodules.
Authors: Bo Liu; Jie Fang; Haipeng Jia; Zhigang Sun; Jian Liao; Hong Meng; Fengmin Pan; Chunhai Li Journal: Thorac Cancer Date: 2019-05-01 Impact factor: 3.500