Computed Tomography-Guided Transfissural Coil Localization of Lung Nodules

Computed tomography-guided localization for multiple pulmonary nodules: a meta-analysis

Introduction

Preoperative computed tomography (CT)-guided localization is commonly employed to facilitate video-assisted thoracoscopic surgery (VATS)-guided diagnostic wedge resection of pulmonary nodules (PNs).

Aim

The present meta-analysis was conducted with the goal of better evaluating the feasibility, safety, and clinical efficacy of preoperative CT-guided localization for multiple PNs (MPNs).

Material and methods

PubMed, Embase, and the Cochrane Library databases were reviewed in order to identify all relevant studies published as of June 2020. Random effects modeling was then used to evaluate the pooled data. The meta-analysis was conducted using Stata v12.0 software.

Results

Eight relevant studies were identified for inclusion in the present meta-analysis. In total, 345 patients with 799 PNs were treated with preoperative CT-guided localization and subsequent wedge resection. The overall pooled technical success rate based on the nodules and patients was calculated to be 97% (95% confidence interval (CI): 0.94-0.99) and 92% (95% CI: 0.86-0.97), respectively. The overall pooled incidence rate of complications was calculated to be 40% (95% CI: 0.16-0.63). Significant heterogeneity was observed among the studies for all the parameters described above (I² = 74.5%, 77.7%, and 96.3%, respectively). No significant differences were detected in the technical success of localization and incidence of complications between coil and hook-wire groups. The risk of publication bias in the reporting of technical success rate of localization based on both nodules and patients was found to be high (p < 0.001 and < 0.001, respectively).

Conclusions

Preoperative CT-guided localization may be effective in guiding VATS-guided wedge resection in patients with MPNs.

Preoperative computed tomography-guided coil localization of sub-centimeter lung nodules

Introduction

Lung nodules (LNs) are often identified in at-risk patients via low-dose computed tomography (CT) approaches. Sub-centimeter (≤ 1 cm) LNs (SCLNs) are particularly difficult for surgeons and pathologists to accurately treat and diagnose.

Aim

To evaluate the clinical efficacy of preoperative CT-guided coil localization for SCLNs.

Material and methods

Between January 2015 and December 2019, consecutive patients at our hospital with SCLNs underwent CT-guided coil localization followed by video-assisted thoracoscopic surgery (VATS). We then assessed rates of technical success corresponding to the localization and VATS-guided wedge resection procedures and measured rates of localization-related complications.

Results

In total, 52 patients were analyzed in this study, with 66 total SCLNs being localized with one coil each. CT-guided coil localization achieved a 93.9% (62/66) technical success rate, and a mean duration of 15.2 ±4.5 minutes. Following coil localization, 6 (11.5%) patients experienced pneumothorax and 4 (7.7%) patients suffered hemoptysis, with 1 patient requiring the insertion of a chest tube to alleviate pneumothorax. VATS-guided wedge resection was associated with a 100% technical success rate, and no patients needed to undergo conversion to thoracotomy. One-stage VATS-guided wedge resection was conducted in the 12 patients with multiple SCLNs. The mean VATS duration was 128.9 ±66.7 minutes, and mean blood loss associated with this procedure was 83.0 ±67.7 ml.

Conclusions

Preoperative CT-guided coil localization can safely and effectively achieve high rates of success when conducting the diagnostic VATS wedge resection of SCLNs.

Computed tomography-guided trans-pulmonary-hepatic approach coil localization for pulmonary nodules near the right lung base

Introduction

Video-assisted thoracoscopic surgery (VATS)-guided diagnostic wedge resection (WR) is frequently used for removal of pulmonary nodules (PNs). Preoperative computed tomography (CT)-guided coil localization (CL) is often used for guidance.

Aim

To evaluate the feasibility, safety, and effectiveness of CT-guided trans-pulmonary-hepatic approach CL of PNs near the right lung base.

Material and methods

Consecutive patients with PNs who underwent CT-guided CL followed by VATS-guided WR at our center from January 2018 to December 2020 were analyzed.

Results

One hundred and twenty-two patients with PNs underwent CT-guided CL followed by VATS-guided WR at our center. Of them, 5 (4.1%) patients had PNs near the right lung base and underwent the CT-guided trans-pulmonary-hepatic approach CL procedures. The technical success rate of CL was 100%. The VATS-guided WR was 100% successful. No patient required thoracotomy.

Conclusions

CT-guided trans-pulmonary-hepatic approach CL for PNs located near the right lung base is technically feasible.

Trans-scapular approach coil localization for scapular-blocked pulmonary nodules: a retrospective study

BACKGROUND

Preoperative computed tomography (CT)-guided coil localization (CL) is commonly used to facilitate video-assisted thoracoscopic surgery (VATS)-guided diagnostic wedge resection (WR) of pulmonary nodules (PNs). When a scapular-blocked PN (SBPN) is localized, the trans-scapular CL (TSCL) is commonly performed. In this study, we investigated the safety, feasibility, and clinical efficacy of preoperative CT-guided TSCL for SBPNs.

MATERIALS AND METHODS

From January 2014 to September 2020, a total of 152 patients with PNs underwent CT-guided CL prior to VATS-guided WR. Of these patients, 14 had SBPNs and underwent the TSCL procedure.

RESULTS

A total of 14 SBPNs were localized in the 14 patients. The mean diameter of the 14 SBPNs was 7.4 ± 2.4 mm. The technical success rate of the scapula puncture was 100%. No complications occurred near the scapula. The technical success rate of CL was 92.9%. One coil dropped off when performing the VATS procedure. The mean duration of the TSCL was 14.2 ± 2.7 min. Two patients (14.3%) developed asymptomatic pneumothorax after TSCL. The technical success rate of VATS-guided WR was 92.9%. The patient who experienced technical failure of TSCL directly underwent lobectomy. The mean duration of the VATS was 90.0 ± 42.4 min and the mean blood loss was 62.9 ± 37.2 ml. The final diagnoses of the 14 SBPNs included invasive adenocarcinoma (n = 4), adenocarcinoma in situ (n = 9), and benign disease (n = 1).

CONCLUSIONS

Preoperative CT-guided TSCL is a safe and simple procedure that can facilitate high success rates of VATS-guided WR of SBPNs.

Computed Tomography-Guided Trans-scapular Coil Localization for Pulmonary Nodules

BACKGROUND

 The aim of the study is to evaluate the feasibility, safety, and effectiveness of preoperative computed tomography (CT)-guided trans-scapular coil localization (TSCL) of scapula-blocked pulmonary nodules (PNs).

METHODS

 Between November 2015 and May 2020, 11 patients underwent preoperative CT-guided TSCL procedures owing to PN occlusion by scapula.

RESULTS

 A 100% technical success rate was achieved for CT-guided TSCL, with one coil being used for each PN. One patient (9.1%) developed pneumothorax. Successful video-assisted thoracoscopic surgery (VATS)-guided wedge resection of these scapula-blocked PNs was conducted in all patients.

CONCLUSION

 CT-guided TSCL can be simply and safely used to facilitate successful VATS-guided wedge resection of scapula-blocked PNs.

Computed tomography-guided coil localization for scapular-blocked lung nodules

PURPOSE

To investigate the clinical efficacy, feasibility, and safety of the preoperative computed tomography (CT)-guided coil localization (CL) approach for scapula-blocked lung nodules (SBLNs).

MATERIAL AND METHODS

A total of 123 patients with LNs were treated via CT-guided CL and subsequent VATS-guided wedge resection from January 2015 to June 2020. Of these patients, 12 (9.8%) exhibited SBLNs and underwent CT-guided CL. Technical success of localization and video-assisted thoracoscopic surgery (VATS)-guided wedge resection, and localization-related complications were recorded and analyzed.

RESULTS

The technical success rate of CT-guided CL was 100%. Each patient was placed with one coil. The mean duration of CT-guided CL was 14.7 ± 2.7 min. One patient (8.3%) developed asymptomatic pneumothorax, which has not impacted the subsequent VATS procedure. Successful VATS-guided wedge resection of these SBLNs was achieved in all patients, with no instances of conversion to thoracotomy. Additional lobectomy was performed in three patients. The mean duration of the VATS procedure and blood loss were 143.8 ± 95.5 min and 110.0 ± 82.0 ml, respectively.

CONCLUSIONS

The approach of CT-guided CL could be safely and easily utilized to facilitate high rates of success when conducting the VATS-guided wedge resection of SBLNs.