SESSION TYPE: Thoracic Surgery I
PRESENTED ON: Monday, October 22, 2012 at 11:15 AM - 12:30 PM
PURPOSE: We report our experiences with a previously described, but underutilized, technique for minimally invasive localization and surgical excision biopsy of small lung nodules—micro-coil guided video-assisted thoracoscopic (MC-VATS) lung resection. Accurate diagnosis of small intrapulmonary lung nodules (0.5-2.0 cm) is a challenge. It can be difficult to reliably biopsy these under CT guidance. Even minimally invasive surgical techniques are difficult, as these nodules often cannot be localized unless the surgeon converts to open thoracotomy to palpate the lung.
METHODS: Sixteen patients had a percutaneous micro-coil placed in the lung, just distal to the target nodule, under CT guidance. Subsequently, the coil was localized during VATS surgery and the coil, along with the target nodule, was excised. Frozen section histological analysis was performed on the target nodule immediately and led to further resection (lobectomy), if clinically indicated. Indications for this procedure included: small nodules (0.5-2cm), deep to the pleura (>0.5cm), or non-palpable pulmonary ground glass opacities.
RESULTS: Successful localization and resection was possible in 15/16 patients leading to definitive diagnoses. Mean diameter of the target nodules was 11mm (4-17mm). Malignancies were diagnosed and treated in 10/16 patients. The other 6 patients with benign nodules received a definite diagnosis and no longer needed followup CTs. The procedure was generally well tolerated. There were no technical or surgical complications. Mortality was zero; morbidity was low—one patient had respiratory failure post-operatively and required reintubation. Median length of stay was 3 days (2-21d).
CONCLUSIONS: Using this technique it is possible to safely and accurately biopsy small non-palpable lung nodules with a minimally invasive procedure (MC-VATS), resulting in limited hospitalizations and minimal morbidities. This technique provides definitive diagnostic (and possibly therapeutic) results because the nodule is resected completely.
CLINICAL IMPLICATIONS: As CT screening for lung cancer becomes more prevalent, many patients with indeterminate pulmonary nodules will be identified. For patients needing a pathological diagnosis, MC-VATS seems to be safe and effective. This retrospective review describes our initial results with this technique and will form the basis for a future prospective trial.
DISCLOSURE: The following authors have nothing to disclose: Syed Quadri, Santiago Miro, Karl Uy, Geoffrey Graeber
We are presenting an approach for biopsy of lung nodules using a combination of interventional radiology and minimally invasive surgical techniques. This technique has been validated in animal and human experiments in the past but is not widely used in the United States.Dept. of Surgery, UMass Memorial Medical Center/University of Massachusetts, Worcester, MA