A new method for accurately localizing and resecting pulmonary nodules

Wang, Gongming; Lin, Yi; Zheng, Lie; Liang, Yin; Zhao, Lei; Wen, Yinsheng; Zhang, Rusi; Huang, Zirui; Yang, Longjun; Zhao, Dechang; Lachkar, Samy; Baste, Jean Marc; Shinagawa, Naofumi; Ng, Calvin S.H.; Sato, Masaaki; Kim, Min P.

doi:10.21037/jtd-20-2089

Cited by 14 publications

(14 citation statements)

References 12 publications

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“…8, 10,20,21 .New methods, sunch as injecting indocyanine green (ICG) under the guidance of electromagnetic navigation bronchoscope,may cost more money and requires more equipment. 22 Common adverse events of localisation and their cause Complications of coil and hookwire are similar. 23,24 Dislodgement is the most common cause for operation failure.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Small Pulmonary Nodule Localisation Using Hookwires or Coils: Strategy Selection in Adverse Events

Zuo¹,

Gao²,

Wen³

et al. 2021

Preprint

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Objective We conducted a retrospective study of adverse events associated with the preoperative procedure of computed tomography (CT)–guided hookwire or coil localisation. We analysed the experience of and process flaws in resecting ground-glass nodules (GGNs) using video-assisted thoracoscopic surgery (VATS) and determined the remedial strategy. Methods Adverse events were evaluated in 20 patients with 25 GGNs who underwent CT-guided hookwire or coil localisation before VATS. For lesions not successfully marked or detected, palpation, resection of the highly suspected area, segmentectomy or lobectomy was performed. Results Among all adverse events, 10 were dislodgement of the marking materials, 2 were breakaway of the marking materials, 4 were >2-cm distance between the lesions and the tip, one was marking material across the two adjacent lobes, 10 were pneumothorax and two were certain parts of marking materials stuck into the walls. All GGNs were resected successfully. Fifteen lesions were detected by palpation. Three GGNs were discovered after the resection of highly suspected areas. The GGNs were removed by lobectomy. Segmentectomies and lobectomies were performed directly on two and four GGNs, respectively. Conclusions When adverse events occur, a second localisation, intraoperative localisation, resection of a highly suspected area, or a segmentectomy or lobectomy can be successfully attempted using VATS for resection of GGNs.

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Section: Discussionmentioning

confidence: 99%

Preoperative Small Pulmonary Nodule Localisation Using Hookwires or Coils: Strategy Selection in Adverse Events

Zuo¹,

Gao²,

Wen³

et al. 2021

Preprint

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“…Ground glass opacifications continue to pose a challenge as preoperatively obtaining tissue samples remains difficult. Preoperative CT or PET/CT scans are often false negative due to the inactive metabolism and the lack of accompanying positive lymph nodes or distant metasteses (21). Even peroperative identification is difficult due to the lack of a solid mass.…”

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confidence: 99%

“…Hence, preoperative localization is often mandatory and can be performed via CT-guided techniques using coils, harpoons, methylene blue or indocyanine green. Alternatively, electromagnetic navigation of fluorescent agent for intraoperative localization of GGO and lung nodules can be used (21). Using 3D reconstruction software, a path is planned for an endoscopic approach to the nodules.…”

mentioning

confidence: 99%

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Diagnosis and treatment of non-small cell lung cancer: current advances and challenges

Diebels¹,

Schil²

2022

J Thorac Dis

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In this editorial we will discuss several interesting and timely topics which are relevant for current thoracic oncological practice. First, we will address epidermal growth factor receptor (EGFR) mutations and resistance, followed by ground glass opacities (GGO), current diagnostic assessment tools including patient derived organoids (PDO), assessment of circulating tumour DNA (ctDNA) and circulation tumour cells (CTC). Finally, we will also address a complex case of delayed extensive chest wall infection following a lobectomy via thoracotomy.The treatment of advanced non-small cell lung cancer (NSCLC) has traditionally been via the systemic administration of platinum-based chemotherapy. Overall survival (OS) is poor with only 33% at 1 year and 11% at 2 years (1). With the discovery of EGFR mutations, new treatment pathways emerged. These mutations are primarily found in lung cancer with an adenocarcinoma component, non-squamous NSCLC, young Asian women (<50 years) and non or light smokers (2). In these patients, if systemic treatment is considered, molecular testing including EGFR mutations need to be assessed. Selective tyrosine kinase inhibitors (TKI) of EGFR (EGFR-TKI) were developed to target EGFR mutation harbouring NCSLC. Via EGFR stimulation, the tyrosine kinase (TK) pathway has a role in cell proliferation and migration, apoptosis evasion, and angiogenesis pathways. In case of EGFR mutated NSCLC activation, this will lead to overstimulation of the EGFR and cause tumour growth.Initial first generation inhibitors of the EGFR-TK pathway, in the form of gefitinib, erlotinib and icotinib were promising. Monotherapy with gefitinib showed an overall response rate (ORR) of 71.2% vs. 47.3% when compared to platinum-based chemotherapy as demonstrated in the IPASS trial (3). Yet the ORR in the population lacking an EGFR mutation was a mere 1.1% (gefinitib group) vs. 23.5% (carboplatin-paclitaxel group). In the WJTOG345 trial, gefitinib was compared to docetaxel and cisplatin in patients with EGFR mutated NSCLC, demonstrating an ORR of 62.1% vs. 32.2% (4). Erlotinib, another first generation EGFR-TKI has been used in the first-line treatment for EGFR mutated NSCLC patients. It showed a progressionfree survival (PFS) of 8.0-13.1 months compared to 4.6-6.9 months in the platinum-based chemotherapy (5).

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“…In case of ground-glass opacity lesions, the location of the tumor through finger touch aloe is more difficult to identify, and secondly, positron emission tomography (PET)-CT easily makes false negatives. There are several methods for nodule localization, including CT-guided markings (blue dye, hookwire, others)-with their logistic problematic, involving pain and pneumothorax-and alternative method of pleural dye marking using radial endobronchial ultrasound and virtual bronchoscopy before performing sublobar pulmonary resection (1).…”

mentioning

confidence: 99%