Chest
Minimally Invasive TechniquesFeasibility and Value of Video-Assisted Thoracoscopic Surgery Wedge Excision of Small Pulmonary Nodules in Patients with Malignancy
Section snippets
Materials and Methods
Between March 2000 and January 2001, we prospectively studied all patients with known malignancies and SmPNs that had been found on routine spiral chest CT scans. Seventeen patients were identified. Six had received a new diagnosis of malignancy, and their lung lesions were identified during a workup for metastatic disease. Eleven patients had new lung lesions noted on CT scans that were obtained as routine follow-ups of previously diagnosed and treated malignancies. The malignancies included
Results
Nodules were removed from 10 different segments involving all lobes. The mean node size was 9.2 ŷ 3.7 mm (size range, 6 to 20 mm). The mean depth was 9.4 ŷ 5.2 mm (depth range, 1 to 20 mm). The nodule could neither be seen nor palpated using standard VATS techniques in 14 of 17 patients (82.4%). None of the malignant tumors could be seen or palpated using conventional VATS techniques. All lesions were resected on the first attempt. The mean (ŷ/SD) count of the lesions was 3,333 ŷ 2,237. The
Discussion
The accurate and timely diagnosis of pulmonary nodules is essential for the proper management of patients with known malignancies. The introduction of spiral CT scanning has resulted in the detection of increased numbers of pulmonary nodules of decreasing size.1 The implications of metastatic lung lesions, no matter what size, on treatment selection for patients who have received a diagnosis of a malignancy are enormous. However, the small size of these lesions makes diagnosis difficult. The
Conclusion
Excisional VATS biopsy after radiolabeled localization of SmPNs is highly reliable, easy to use, and reproducible. VATS excision can be accomplished with low morbidity. The high incidence of malignant diagnoses confirms the value of accurate and timely diagnoses in patients with known malignancies. The fear of thoracotomy and its associated morbidities should not be a limiting factor in the workup of SmPNs. This should encourage clinicians to aggressively seek the earlier diagnosis of SmPNs in
ACKNOWLEDGMENT
Thanks to Ms. Pegeen Anderson for her help in preparation of this manuscript.
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Cited by (71)
CT guided injection of <sup>99m</sup>Tc-MAA for lung nodule localization prior to VATS
2022, Clinical ImagingCitation Excerpt :Those reports highlight the need for pre-operative localization of small and deep nodules. Previous studies have found high success rates (95–100%) for nodule localization using 99mTc-based radiotracers alone or in combination (Supplemental Table 5).11,15–23 In our study, the success rate of 96.1% is consistent with previous reports.
Intraoperative Molecular Imaging of Lung Cancer: A Review
2022, Surgical Oncology Clinics of North AmericaCitation Excerpt :Many methods of preoperative localization of lung nodules have been developed but they all have disadvantages. Most commonly, patients undergo CT-guided placement of a hookwire5 or fiducial marker or injection of methylene blue dye or a radiotracer.6 These procedures are performed in a radiology suite and must be coordinated with the operating rooms.
The Utility of Indigo Carmine and Lipiodol Mixture for Preoperative Pulmonary Nodule Localization before Video-Assisted Thoracic Surgery
2019, Journal of Vascular and Interventional RadiologyNovel Methods of Intraoperative Localization and Margin Assessment of Pulmonary Nodules
2016, Seminars in Thoracic and Cardiovascular Surgery
This study was presented at Chest 2001, November 4 to 8, 2001, Philadelphia, PA.