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Cardiothoracic Surgery |

Technetium to Localize Small or Ground Glass Pulmonary Nodules for VATS Resection

Ankit Dhamija*, MD; Eric Reiner, MD; Ami Rubinowitz, MD; Xiaojie Guo, MSPH; Mary Finan, PA; Anthony Kim, MD; Frank Detterbeck, MD; Daniel Boffa, MD
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Morristown Medical Center, Morristown, NJ


Chest. 2012;142(4_MeetingAbstracts):54A. doi:10.1378/chest.1389841
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Abstract

SESSION TYPE: Thoracic Surgery Posters I

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: CT guided injection of technetium can be used to localize pulmonary nodules that are either too small, or lack a sufficient solid component to be identified during a Video Assisted Thoracic Surgery (VATS) approach. Furthermore localization may prevent the inadvertent traversing of a potential cancer and thus preserve a margin of normal tissue around the resected lesion, the merits of which are at the very core of surgical oncology. We evaluated our single institution’s experience with this technique to evaluate the types of nodules localized, the success rates of localization, and the ability to obtain a negative margin for wedge-resected malignancies.

METHODS: A retrospective review was performed on a prospectively maintained database.

RESULTS: From 2006 to 2011, CT-guided technetium injection was used to localize 58 nodules in 54 patients. The median size of the pulmonary nodule was 1.2 cm +/- 0.6 cm. Overall 44.8% of the nodules were almost entirely ground glass (Suzuki 1 or 2), 17.2% were purely solid (Suzuki 6) while 32.8% were mixed (Suzuki 3, 4, 5). The median distance of the nodule from the innermost chest wall or nearest fissure was 0.61cm (range 0-3.2), and the median time from needle localization to the beginning of the procedure was 191min (range 79-348). A pneumothorax developed in 6 patients as a result of the localization procedure, with only one requiring an intervention prior to surgery (pig tail catheter). Overall 96% of nodules were successfully identified by VATS following localization (56/58). Excised nodules represented primary lung cancer (60%), pulmonary metastases (16%), and benign lesions (24%). Of the malignant nodules, 98% were removed with a negative margin.

CONCLUSIONS: CT guided technetium injection is an effective technique to localize small or predominantly ground glass pulmonary nodules unlikely to be palpable during a VATS resection. Technetium localization allows the nodule to be adequately positioned within a wedge to consistently obtain negative margins.

CLINICAL IMPLICATIONS: Localization allows clinicians to utilize wedge resection for the diagnosis and treatment of early lung cancer as imaging captures progressively more subtle lung cancers. Further study is needed to evaluate the ability of technetium localized wedge resection to provide local control of pulmonary malignancies.

DISCLOSURE: The following authors have nothing to disclose: Ankit Dhamija, Eric Reiner, Ami Rubinowitz, Xiaojie Guo, Mary Finan, Anthony Kim, Frank Detterbeck, Daniel Boffa

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Morristown Medical Center, Morristown, NJ

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