Anna L McGuire1, Arthur Vieira2, Kyle Grant2, John Mayo3, Tony Sedlic4, James Choi2, John Yee5. 1. Vancouver Coastal Health Research Institute, Vancouver General Hospital, Vancouver, British Columbia, Canada; Department of Surgery, Division of Thoracic Surgery, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: anna.mcguire@vch.ca. 2. Department of Surgery, Division of Thoracic Surgery, University of British Columbia, Vancouver, British Columbia, Canada. 3. Vancouver Coastal Health Research Institute, Vancouver General Hospital, Vancouver, British Columbia, Canada; Thoracic Service, Department of Diagnostic Medical Imaging, University of British Columbia, Vancouver, British Columbia, Canada. 4. Thoracic Service, Department of Diagnostic Medical Imaging, University of British Columbia, Vancouver, British Columbia, Canada. 5. Vancouver Coastal Health Research Institute, Vancouver General Hospital, Vancouver, British Columbia, Canada; Department of Surgery, Division of Thoracic Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
Abstract
OBJECTIVE: The study objective was to provide a 5-year update on our tertiary-level institutional experience with computed tomography-guided platinum microcoil lung surgery. METHODS: A retrospective cross-sectional study was conducted. All patients admitted to the Thoracic Service at Vancouver General Hospital to undergo computed tomography-guided microcoil lung surgery were included. Key primary outcome variables were successful nodule localization and severity of adverse events associated with placement. Secondary outcomes included nodule characteristics on preoperative computed tomography chest and nodule surgical pathology. Continuous variables were reported as mean (± standard deviation), and counts were reported as proportions n (%). RESULTS: A total of 97 lung nodules were resected in 92 patients. Mean age was 65.3 (±10.6) years, and 59 (61%) were female. All 97 nodules (100%) were successfully localized using video-assisted thoracic surgery wedge resection. There were 59 cases (60.8%) of placement-related events noted on computed tomography of the chest. All were minor and self-limited in nature and did not require treatment: pneumothorax 45 (46.4%), lung hematoma 18 (18.6%), dislodgement 4 (4.1%), and hemoptysis 2 (2.1%). Mean nodule diameter was 13.2 mm (±6.7). Density was nonsolid in 27 (27.8%) and semi-solid in 27 (27.8%). There was a single case of positive surgical margin, and 4 (4.1%) went on to completion lobectomy. Non-small lung cancer was identified in 66 nodules. CONCLUSIONS: Computed tomography-guided platinum microcoil lung surgery is safe with a favorable clinical adverse event profile and is suitable for poor-risk patients. The method is efficient, yielding 100% diagnostic localization in our 5-year update. It eliminates the need for thoracotomy and palpation to localize worrisome subpleural tiny nodules. It is ideal for the management of changing nodules concerning for early lung cancer and diagnosis of small indeterminate lung nodules or metastases.
OBJECTIVE: The study objective was to provide a 5-year update on our tertiary-level institutional experience with computed tomography-guided platinum microcoil lung surgery. METHODS: A retrospective cross-sectional study was conducted. All patients admitted to the Thoracic Service at Vancouver General Hospital to undergo computed tomography-guided microcoil lung surgery were included. Key primary outcome variables were successful nodule localization and severity of adverse events associated with placement. Secondary outcomes included nodule characteristics on preoperative computed tomography chest and nodule surgical pathology. Continuous variables were reported as mean (± standard deviation), and counts were reported as proportions n (%). RESULTS: A total of 97 lung nodules were resected in 92 patients. Mean age was 65.3 (±10.6) years, and 59 (61%) were female. All 97 nodules (100%) were successfully localized using video-assisted thoracic surgery wedge resection. There were 59 cases (60.8%) of placement-related events noted on computed tomography of the chest. All were minor and self-limited in nature and did not require treatment: pneumothorax 45 (46.4%), lung hematoma 18 (18.6%), dislodgement 4 (4.1%), and hemoptysis 2 (2.1%). Mean nodule diameter was 13.2 mm (±6.7). Density was nonsolid in 27 (27.8%) and semi-solid in 27 (27.8%). There was a single case of positive surgical margin, and 4 (4.1%) went on to completion lobectomy. Non-small lung cancer was identified in 66 nodules. CONCLUSIONS: Computed tomography-guided platinum microcoil lung surgery is safe with a favorable clinical adverse event profile and is suitable for poor-risk patients. The method is efficient, yielding 100% diagnostic localization in our 5-year update. It eliminates the need for thoracotomy and palpation to localize worrisome subpleural tiny nodules. It is ideal for the management of changing nodules concerning for early lung cancer and diagnosis of small indeterminate lung nodules or metastases.