Preoperative radio-guided localization of lung nodules with I-125 seeds: experience with 32 patients at a single institution

Abstract

OBJECTIVES Videothoracoscopic visualization and/or palpation of pulmonary nodules may be difficult due to their location, small size or limited solid component. The purpose of this study is to present our experience with computed tomography (CT)-guided preoperative localization of pulmonary nodules by percutaneous marking with radio-labelled iodine-125 seeds. METHODS A total of 34 pulmonary nodules were marked under CT with the placement of 33 radio-labelled iodine-125 seeds in 32 consecutive patients. RESULTS All patients underwent biportal video-assisted thoracic surgery (VATS) and in no case was conversion to thoracotomy necessary. A total of 88.2% of the lung nodules were successfully resected. In the remaining 11.8%, migration of the seed to the pleural cavity occurred, although these nodules were still resected during VATS. Of all the patients with pneumothorax after the marking procedure, only one required chest tube placement (3.1%). No major postoperative complications were observed. CONCLUSIONS Preoperative marking of pulmonary nodules with I-125 seeds under CT guidance is a feasible and safe technique that allows their intraoperative identification and resection.

Surgical treatment in lung cancer

“…En este sentido la localización de la lesión nodular mediante navegación electromagnética endobronquial (NEM) y su marcaje con diversas sustancias como verde de indocianina o isótopos radiactivos, permite la localización en el mismo procedimiento de la lesión por vía toracoscópica y su ulterior resección (61). También es posible insertar semillas radiactivas por vía transtorácica guiada por tomografía computarizada (62).…”

Minimally Invasive Surgery in Non-Small Cell Lung Cancer: Where Do We Stand?

“…Failure of nodule localization can lead to conversion to open surgery with some studies reporting rates up to 63%, especially for GGO and nodules < 10 mm in diameter or located >5 mm deep from the pleura [85]. Several strategies exist to approach this problem, such as CT-guided localization techniques using hook wire positioning or microcoil placement, preoperative marking with radio-labelled iodine-125 seeds, percutaneous or intravenous injection of liquid agents, and intraoperative ultrasound [27][28][29]. However, complications and practical issues have been reported for several of these techniques.…”

“…For the thoracic surgeon, this means an increase in patients that are eligible for segmentectomy, a significantly more complex procedure than lobectomy, in addition to more challenging localizations of nodules due to their smaller sizes. Techniques such as radio-guided localization, microcoil/hookwire placement, intraoperative ultrasonography, fluorescence-guided lung nodule identification, and navigational bronchoscopy will be useful tools for surgeons in these cases [26][27][28][29]. This review aims to provide a summary of the latest data regarding surgical techniques and treatment outcomes for MIS in the management of lung cancer.…”

Subsolid pulmonary nodules: why not “watch and wait”?

“…If all Lung-RADS category 2 nodules are aggressively managed, there is a high risk of increasing the rate of overdiagnosis (i.e., resecting indolent tumours with no metastatic potential that would never lead to the death of the patient). We should bear in mind that both surgery ( 16 ) and nodule marking procedures [with wire-hooks ( 17 ), coils ( 18 ), dye ( 19 ), radioactive materials ( 20 )…] are not without risk.…”