Background Identification of small pulmonary nodules is challenging in a limited intrathoracic field during minimally invasive video‐assisted thoracoscopic surgery (VATS), and preoperative localization is required. Various techniques have been reported with some failure and complications. Here, we compare the feasibility and safety between electromagnetic navigation bronchoscopic marking and computed tomography (CT)‐guided percutaneous marking using indocyanine green (ICG) and iopamidol. Methods A total of 47 patients with small‐sized pulmonary nodules, scheduled to undergo video‐assisted thoracoscopic limited resection, were enrolled in this study. A mixture of diluted ICG and iopamidol was injected into the lung parenchyma as a marker, using CT‐guided percutaneous or electromagnetic navigation bronchoscopic injection techniques and the results were examined and compared. Results A total of 35 and 12 patients underwent preoperative marking by percutaneous injection and electromagnetic navigation bronchoscopic injection, respectively, in which a marker was detected in 33/35 (94.3%) and 12/12 (100%) patients. No combination of these procedures was performed in any patient. All markers were successfully detected in three patients who underwent injection marking at two different lesion sites. Pneumothorax occurred in five patients (14%) in the percutaneous marking group, which was relieved in all patients without the necessity for chest tube drainage. No other complication was observed in this study. Conclusions Electromagnetic navigation bronchoscopic injection techniques using indocyanine green fluorescence plus iopamidol are safe and effective, and comparable with CT‐guided localization. Furthermore, a bronchoscopic approach enables marking of multiple lesion areas without increasing patient risk, especially for puncture‐related pneumothorax. Key points Significant findings of the study Either computed tomography (CT)‐guided percutaneous or electromagnetic navigation bronchoscopic injection techniques can be used for preoperative marking of pulmonary nodules with indocyanine green (ICG) fluorescence. What this study adds Indocyanine green (ICG) is a safe and easily detectable fluorescent marker for video‐assisted thoracoscopic surgery (VATS). A bronchoscopic injection approach enables marking of multiple lesion areas without increasing the risk of pneumothorax.

PurposeThe purpose of this study was to create a mathematical model based on the metabolic parameters of PET/CT with clinicopathological characteristics to predict the EGFR mutation status of patients with lung adenocarcinoma.MethodsThis study retrospectively enrolled patients with lung adenocarcinoma who underwent surgical treatment at two centres in China between January 2012 and December 2015. PET/CT metabolic parameters and Classical EGFR mutation status detection by molecular pathology were performed before and after surgery, and we analysed the associations of EGFR mutation status with patient sex, age, smoking history, maximum primary lesion diameter, carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), cytokeratin 19 fragment (CYFRA21-1), TNM stage and histopathological subtype of lung adenocarcinoma.ResultsA total of 310 patients were included, comprising 161 with EGFR mutations (51.9%) and 149 with wild-type EGFR (48.1%). EGFR mutations were more common in females, non-smokers, and those with stage IV disease, a low SUVmax, and ≤35 mm nodules, whereas wild-type EGFR was more common in males, smokers, and those with a solid growth pattern. Multivariate analysis suggested that liver SUVratio, smoking history, tumour size, TNM stage, and solid growth pattern can predict EGFR mutation status, and these factors were used to construct a mathematical model.ConclusionThe prediction model constructed in this study based on clinicopathological characteristics and PET/CT parameters might offer a basis by which to predict Classical EGFR status and provide a certain reference value for guiding the use of EGFR-tyrosine kinase inhibitor (EGFR-TKI) treatment in patients with lung adenocarcinoma.

BackgroundRearrangements of the anaplastic lymphoma kinase (ALK) gene comprise a small subset of non-small cell lung cancer (NSCLC). Patients with NSCLC harboring ALK fusion proteins are sensitive to ALK tyrosine kinase inhibitors (TKIs). Various fusion partners of ALK are being discovered with the application of next-generation sequencing (NGS).Case presentationHere, we report a female patient with metastatic lung adenocarcinoma harboring LMO7-ALK (L15, A20) rearrangement revealed by NGS. The patient received crizotinib as first-line treatment and has achieved partial response with a progression-free survival over 1 year.ConclusionsWe firstly found that the satisfactory response to crizotinib verified the oncogenic activity of LMO7-ALK fusion. Great progression and wide application of NGS facilitate the findings of rare fusion types.