99mTechnetium and methylene blue guided pulmonary nodules resections: preliminary British experience

Nardini, Marco; Rocco, Bernardo; Paul, Ian; Jayakumar, Shruti; Papoulidis, Pavlos; Elsaegh, Mohamed; Hartley, R. B.; Richardson, Mark A.; Misra, Pankash; Migliore, Marcello; Dunning, Joel

doi:10.21037/jtd.2018.01.143

Cited by 23 publications

(16 citation statements)

References 16 publications

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“…It is difficult to identify pulmonary nodules by methylene blue because it can quickly spread to the pleural surface [26]. Specific radioactive tracers, such as 99 m Technetium, are feasible for preoperative localization of small pulmonary nodules [27]. Although specific radioactive tracers are more accurate for preoperative localization of superficial pulmonary nodules, specialised equipment such as CT-fluorescence is required [28], and surgeons and radiologists could be exposed to radiation.…”

Section: Discussionmentioning

confidence: 99%

CT-guided hook-wire localization of malignant pulmonary nodules for video assisted thoracoscopic surgery

Zhang

Liu

Yimin

et al. 2020

J Cardiothorac Surg

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Objectives Video assisted thoracoscopic surgery (VATS) can currently be used to diagnose and treat pulmonary nodules. However, intraoperative location of pulmonary nodules in VATS is challenging due to their small diameter and deep location in the pulmonary parenchyma. The purpose of this study was to report the clinical safety and effectiveness of CT-guided hook-wire for preoperative localization of malignant pulmonary nodules smaller than 1 cm in diameter. Methods From February 2017 to January 2018, we collected the data of 80 patients with malignant pulmonary nodules less than 1 cm in diameter who underwent CT-guided hook-wire preoperative localization and VATS surgery. The effectiveness of preoperative localization was evaluated based on surgical duration, success rate of VATS surgery, and localization-related complications. Results The diameter of pulmonary nodules were 0.85 ± 0.17 mm with a distance to the pleural surface of 19.66 ± 14.10 mm. The length of the hook-wire in the lung parenchyma was 29.17 ± 13.14 mm and hook-wire dislodgement occurred in 2 patients. Complications included 27 cases of minor pneumothorax and 18 cases of mild parenchymal hemorrhage. A significant correlation was observed between the length of the hook-wire in the lung parenchyma and mild parenchymal hemorrhage (P = 0.044). The average time of hook-wire localization was 9.0 ± 2.6 min and the average operation time for VATS was 89.02 ± 23.35 min without conversion thoracotomy. Conclusions CT-guided hook-wire localization of the lesion during VATS resection is safe for malignant pulmonary nodules with diameter less than 1 cm.

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Section: Discussionmentioning

confidence: 99%

CT-guided hook-wire localization of malignant pulmonary nodules for video assisted thoracoscopic surgery

Zhang

Liu

Yimin

et al. 2020

J Cardiothorac Surg

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show abstract

“…It is di cult to identify pulmonary nodules by methylene blue because it can quickly spread to the pleural surface [26]. Speci c radioactive tracers, such as 99m Technetium, are feasible for preoperative localization of small pulmonary nodules [27]. Although speci c radioactive tracers are more accurate for preoperative localization of super cial pulmonary nodules, specialised equipment such as CT-uorescence is required [28], and surgeons and radiologists could be exposed to radiation.…”

Section: Discussionmentioning

confidence: 99%

CT-Guided Hook-Wire Localization of Malignant Pulmonary Nodules for Video Assisted Thoracoscopic Surgery

Zhang

Liu

Yimin

et al. 2020

Preprint

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Objectives: Video assisted thoracoscopic surgery (VATS) can currently be used to diagnose and treat pulmonary nodules. However, intraoperative location of pulmonary nodules in VATS is challenging due to their small diameter and deep location in the pulmonary parenchyma. The purpose of this study was to report the clinical safety and effectiveness of CT-guided hook-wire for preoperative localization of malignant pulmonary nodules smaller than 1 cm in diameter.Methods: From February 2017 to January 2018, we collected the data of 80 patients with malignant pulmonary nodules less than 1 cm in diameter who underwent CT-guided hook-wire preoperative localization and VATS surgery. The effectiveness of preoperative localization was evaluated based on surgical duration, success rate of VATS surgery, and localization-related complications.Results: The diameter of pulmonary nodules were 0.85 ± 0.17 mm with a distance to the pleural surface of 19.66 ± 14.10 mm. The length of the hook-wire in the lung parenchyma was 29.17 ± 13.14 mm and hook-wire dislodgement occurred in 2 patients. Complications included 27 cases of minor pneumothorax and 18 cases of mild parenchymal hemorrhage. A significant correlation was observed between the length of the hook-wire in the lung parenchyma and mild parenchymal hemorrhage (P = 0.044). The average time of hook-wire localization was 9.0 ± 2.6 min and the average operation time for VATS was 89.02 ± 23.35 min without conversion thoracotomy.Conclusions: CT-guided hook-wire localization of the lesion during VATS resection is safe for malignant pulmonary nodules with diameter less than 1 cm.

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“…Intraoperatively, a core of lung parenchyma surrounding the wire was resected using a laser (argon or neodymium:yttrium aluminum garnet) (19). Over the years, this technique has evolved and now includes a wider variety of markers to facilitate resection (gold fiducials, methylene blue dye, radiolabeled isotopes) (5,8,21). The reported overall success of this two-step approach locating the target lesion ranges from 90% to 93% (4,13,20).…”

Section: Localization Techniquesmentioning

confidence: 99%

“…Pure ground glass opacities (GGO), partially solid, and solid nodules less than 1 cm can be managed with close observation, percutaneous biopsy, navigational biopsy, or excisional biopsy, depending on clinical factors and associated imaging findings (2)(3)(4). Percutaneous or navigational biopsy may fail to obtain a diagnosis due to inadequate sampling of the target lesion (2)(3)(4)(5)(6)(7)(8)(9). The accuracy of biopsy diminishes with smaller (<1 cm) targets and pure ground glass lesions (2).…”

Section: Introductionmentioning

confidence: 99%

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Image-guided video assisted thoracoscopic surgery (iVATS) and the future of surgical management

Steimer¹,

White²

2022

Curr Chall Thorac Surg

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The increased utilization of computed tomography for diagnostic imaging has led to an influx of incidentally discovered pulmonary nodules. Both thoracic surgeons and radiologists are burdened with risk stratifying these lesions for observation versus biopsy or resection. The diagnostic accuracy of percutaneous biopsy is dependent on the lesion's size, density, and anatomic location. Nodules that are not amenable to percutaneous biopsy are often referred to surgeons for excisional biopsy. Certain characteristics make some lesions more difficult to resect than others. Small (<1 cm), partially solid, pure ground glass, and central lesions can be difficult to palpate intraoperatively. These lesions can be challenging to resect with thoracoscopic and robotic assisted approaches due to diminished tactile feedback and smaller incisions. Over the past 30 years, techniques have been developed to assist surgeons in locating these lesions with the use of hook wires, fiducials, dyes, and radiolabeled isotopes. These markers are placed preoperatively but are prone to migration or diffusion. In this chapter a new localization and resection technique, image-guided video assisted thoracoscopic surgery (iVATS) is reviewed. iVATS is an attractive option for both patients and surgeons since the localization procedure and parenchymal resection are performed under a single anesthetic.A detailed description of the iVATS technique, success rate, and common complications are reviewed. For pulmonary nodules that are centered within a defined bronchovascular segment, upfront segmentectomy is a reasonable option for obtaining pathologic diagnosis. Since segmentectomy relies on surgeon knowledge and experience with segmental anatomy, non-palpable lesions can be easily treated with this technique. Pearls and pitfalls of the most common segmental resections are addressed. Despite the refinement of localization techniques, small pulmonary nodules continue to present a diagnostic challenge. Ongoing innovation of new clinical tools has generated promising options for the future. In this chapter, we will review some of the tools undergoing development including computer generated algorithms for nodule risk assessment, liquid biopsy, three-dimensional printing, and superselective segmentectomy. Some technologies are focused on creating non-invasive methods to determine if a nodule is benign or malignant, while others seek to improve localization techniques. All of the described tools will need further validation but will potentially streamline the diagnosis and treatment of pulmonary nodules for future clinical practice.

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99mTechnetium and methylene blue guided pulmonary nodules resections: preliminary British experience

Cited by 23 publications

References 16 publications

CT-guided hook-wire localization of malignant pulmonary nodules for video assisted thoracoscopic surgery

CT-guided hook-wire localization of malignant pulmonary nodules for video assisted thoracoscopic surgery

CT-Guided Hook-Wire Localization of Malignant Pulmonary Nodules for Video Assisted Thoracoscopic Surgery

Image-guided video assisted thoracoscopic surgery (iVATS) and the future of surgical management

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