Ultrasonographic localization of occult pulmonary nodules during video-assisted thoracic surgery

Abstract

The aim of our study was to evaluate the role of ultrasonography in the localization of pulmonary nodules during video-assisted thoracic surgery (VATS). Ultrasonography was performed in 35 patients for the localization of pulmonary nodules during VATS. Indication for VATS was excisional biopsy of undetermined nodules in 22 patients, single or multiple metastasectomy in 12 patients and resection of primitive pulmonary cancer in 1 patient with reduced pulmonary reserve. A laparoscopic probe with flexible head and multi-frequency transducer (5-7.5 MHz) was used. Intraoperative ultrasonography localized 37 of 40 nodules preoperatively detected by CT and/or by positron emission tomography in 35 patients. Furthermore, ultrasonography localized two nodules not visualized at spiral CT. Eighteen nodules were not visible or palpable at thoracoscopic examination and were found by intraoperative sonography only. In 6 patients in whom thoracotomy was performed, manual palpation did not reveal more lesions than ultrasonography. In our experience, ultrasonography was very helpful when lesions were not visible or palpable during thoracoscopy, showing high sensitivity (92.5%) in finding pulmonary nodules. Since it is not possible to determine preoperatively whether a localization technique will be necessary during the operation or not, and ultrasonography is a non-invasive technique, we think that, at present, this technique can be considered as the first-instance localization technique during thoracoscopic resection of pulmonary nodules.

CT-guided microcoil VATS resection of lung nodules: a single-centre experience and review of the literature

“…Although most studies report the actual ultrasound procedure time to be quite low, the time to deflate the lung can be quite lengthy in patients with emphysematous lungs, and many patients who have small pulmonary nodules fall into this group (41,42). In one series, ultrasonography wasn't attempted until the lung had been excluded from ventilation for at least 40 min (43). Also, there is a learning curve associated with use of the ultrasound equipment, with some studies reporting the presence of a radiologist in the operating room (38,43,44).…”

“…In one series, ultrasonography wasn't attempted until the lung had been excluded from ventilation for at least 40 min (43). Also, there is a learning curve associated with use of the ultrasound equipment, with some studies reporting the presence of a radiologist in the operating room (38,43,44). Suggestion has been made that nodules can be diagnosed based on their ultrasonographic characteristics, but more work must be done in this area (41,45).…”

Intrathoracoscopic localization techniques

“…The number of patients included in these series is low (average <20 patients per study), with the highest being 35 patients in the study by Piolanti et al [53]. Interestingly, some authors employed this technique to localize pulmonary cancers and mediastinal structures (Table 1).…”

“…Several perspective studies have shown that the intrathoracoscopic US technique is, in experienced hands, very sensitive and shows a good percentage of nodule localization, ranging from 70 to 100% [10,18,21,36,38,53,57,62,66,67,82]. The number of patients included in these series is low (average <20 patients per study), with the highest being 35 patients in the study by Piolanti et al [53].…”

Ultrasonography for Localization of Subcentimetre Lung Nodules

“…The use of ultrasonography for the localization of lung nodules has been reported since in the 1990s [1][2][3][4][5][6][7][8]. Although described in 1990s this technology has not been fully adapted to thoracic surgery.…”