PURPOSE: The aim of this study was to evaluate the feasibility of a dual localization with radiotracer and hookwire before needlescopic resection for pulmonary nodule.
METHODS: CT fluoroscopy-guided dual marking with hookwire and 99mTc-phytate was performed on 49 pulmonary nodules of 42 patients just before the needlescopic procedure. These combined methods were carried out through one introducer needle after an initial single-puncture. Needlescopic resection of pulmonary nodule was performed guided by hookwire and gamma radioprobe. The specimen was histologically diagnosed by a routine intraoperative pathologic examination.
RESULTS: The mean age of the patients was 62.8±10.48 years (range, 36-83 years). The mean size of the nodules was 10.7±3.83 mm (range, 3-18 mm). Their mean distance from the pleural surface was 10.7±3.83 mm (range, 0-18 mm). There were 12 pure ground glass opacity lesions, 16 semisolid lesions and 21 solid lesions. The time of the dual localization procedure was 12.2±3.6 (range 6-24) minutes. Pneumothorax was developed in in 7 of 42 patients (16.7%) after preoperative localization, but it needed no treatment. Eight hookwires dislodged during the operation. Nevertheless, radiotracer markings detected on gamma radioprobe guided a successful wedge resection without difficulty. All nodules were successfully resected under needlescopy except conversion to the 5mm-sized thoracoscopy in 2 patients and the minithoracotomy in 3 due to pleural adhesion. Twenty-three of 49 nodules were metastasis, 16 nodules were benign lesions, and 10 nodules were primary lung cancers. There was no complication related to needlescopic wedge resection.
CONCLUSIONS: Dual marking with radiotracer and hookwire under CT fluoroscopy is a safe and no time consuming procedure, and needlescopic lung resection for small nodules is a technically feasible and useful for histologic diagnosis and treatment.
CLINICAL IMPLICATIONS: This technique has now made it possible both to detect small pulmonary lesions quickly without lung injury and to secure the target lesion even in case of the dislodge of hookwire.
DISCLOSURE: The following authors have nothing to disclose: Hyun Koo Kim, Hwan Seok Yong, Sungeun Kim, Hyun Joo Lee, Yuhua Quan, Se Hyun Lim, Eun-Young Kang, Young Ho Choi
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