Preoperative computed tomography-guided localization for multiple pulmonary nodules: comparison of methylene blue and coil

Abstract

Background Preoperative computed tomography (CT)-guided localization has been used to guide the video-assisted thoracoscopic surgery (VATS) sublobar (wedge or segmental) resection for pulmonary nodules (PNs). We aimed to assess the relative efficacy and safety of CT-guided methylene blue (MB)- and coil-based approaches to the preoperative localization of multiple PNs (MPNs). Methods Between January 2015 and December 2020, 31 total cases suffering from MPNs at our hospital underwent CT-guided localization and subsequent VATS resection in our hospital, of whom 15 and 16 respectively underwent MB localization (MBL) and coil localization (CL). The clinical effectiveness and complication rates were compared between 2 groups. Results The PN- and patient-based technical success rates in the MBL group were both 100%, whereas in the CL group they were 97.2% (35/36) and 93.8% (15/16), respectively, with no substantial discrepancies between groups. Patients in the MBL group illustrated a substantially shorter CT-guided localization duration compared with the CL group (18 min vs. 29.5 min, P < 0.001). Pneumothorax rates (P = 1.000) and lung hemorrhage (P = 1.000) were comparable in both groups. In the MBL and CL groups, the median interval between localization and VATS was 1 h and 15.5 h, respectively (P < 0.001). One-stage VATS sublobar resection of the target nodules was successfully performed in all patients from both groups. Conclusion Both CT-guided MBL and CL can be readily and safely utilized for preoperative localization in individuals who had MPNs, with MBL being correlated with a shorter localization duration compared with CL.

‘Now you can see me, now you don’t’: seeking the invisible lung nodule

“…MIS can offer many advantages such as reduced anaesthesia and hospitalization time, less tissue damage and pain, decreased intraoperative blood loss, lower risk of postoperative infection and complications, better cosmetic outcome and faster recovery compared to traditional open technique [ 1–4 ]. When conducted together with an enhanced recovery after surgery protocol, VATS may produce better results with a significantly reduced length of hospital stay and postoperative complication incidence [ 5 ].…”

“…Recent advances and more widespread application of computational tomography (CT) including the use of low-dose high-resolution CT protocols have allowed for the early detection of small pulmonary nodules (PNs) and improved early-stage lung cancer screening [ 5 , 6 ]. VATS is routinely utilized for the early diagnosis and treatment of these PNs [ 5 , 6 ]. However, small, deeply positioned PNs can be difficult to visualize and locate during VATS.…”

“…Factors such as size, density and distance to the pleural surface can influence the nodule detection rate. Therefore, a number of studies have reported that up to 63% of patients undergoing VATS to resect PNs <10 mm in diameter or >5 mm from the pleura ultimately have to undergo conversion to thoracotomy [ 5 ]. Trying to reduce these conversion rates, many studies have explored the use of preoperative and intraoperative localization techniques to guide surgeons during VATS resection of PNs [ 5 ].…”

“…Therefore, a number of studies have reported that up to 63% of patients undergoing VATS to resect PNs <10 mm in diameter or >5 mm from the pleura ultimately have to undergo conversion to thoracotomy [ 5 ]. Trying to reduce these conversion rates, many studies have explored the use of preoperative and intraoperative localization techniques to guide surgeons during VATS resection of PNs [ 5 ]. Some of the most frequently utilized techniques for localization include the use of preoperative CT-guided tags such as mechanical coils or hook-wires, methylene blue or indigo-carmine dyes, contrast media and radiotracers such as technetium-99m [ 5 , 6 ].…”

“…Trying to reduce these conversion rates, many studies have explored the use of preoperative and intraoperative localization techniques to guide surgeons during VATS resection of PNs [ 5 ]. Some of the most frequently utilized techniques for localization include the use of preoperative CT-guided tags such as mechanical coils or hook-wires, methylene blue or indigo-carmine dyes, contrast media and radiotracers such as technetium-99m [ 5 , 6 ]. However, the preoperative labelling procedure is time consuming and may cause patient discomfort, complications such as pneumothorax or/and haemoptysis and radiation exposure, while dislodgement of the tag can often occur [ 7 , 8 ].…”