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Hsu WC, Chen KA, Pan KT, Chang PC, Wu CF, Fu JY, Hsieh MJ, Liu YH, Wu CY. Safety and feasibility comparison between three different CT-guided localization techniques under systemic approach algorithm. Eur J Radiol 2024; 172:111322. [PMID: 38295549 DOI: 10.1016/j.ejrad.2024.111322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/16/2023] [Accepted: 01/12/2024] [Indexed: 02/02/2024]
Abstract
INTRODUCTION In the era of lung cancer screening, more and more sub-centimeter indeterminate lung lesions are being identified. It is difficult to approach these lesions and obtain tissue to confirm diagnosis. CT-guided navigation followed by surgical resection is the best way to overcome this difficulty. The aim of this study is to compare the safety and feasibility of wire and dye-tattoo CT-guided localization techniques. MATERIALS AND METHODS From September 2019 to August 2021, 418 patients who presented with single lung lesion and received single CT-guided localization were included in this study. Procedure details, navigation results, and related complications were compared. RESULTS For patients who received wire localization, majority (98.3 %) had perihilar lesions. In addition, 68 (57.1 %) patients received tangential approach because of lesions were blocked by bony or vital structure, abutting major fissure, or previous approach failure. The characteristics of lesion location was quite different than dye-tattooing technique (p = 0.033). As regards persistence of the target lesion localization, the interval between localization and surgery using ICG tattooing was 829.0 ± 552.9 min; much longer than the other two navigation techniques (p < 0.0001). As regards safety, patients who received wire localization had a higher rate of pneumothorax (p = 0.042) and pulmonary hemorrhage (p < 0.001) than the dye-tattooing techniques. DISCUSSION CT-guided navigation techniques are safe and feasible. Wire localization is suitable for centrally located lesions but the wire needs to be fixed properly and symptomatic pneumothorax monitored for. Dye-tattooing is more suitable for peripheral lesions, while ICG localization persists longer than other techniques.
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Affiliation(s)
- Wen-Chi Hsu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Taiwan; Chang Gung University, Taiwan
| | - Kuei-An Chen
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Taiwan; Chang Gung University, Taiwan
| | - Kuang-Tse Pan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Taiwan; Chang Gung University, Taiwan
| | - Po-Chun Chang
- Department of Surgery, Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ching-Feng Wu
- Chang Gung University, Taiwan; Department of Surgery, Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Jui-Ying Fu
- Chang Gung University, Taiwan; Department of Internal Medicine, Division of Critical Care and Pulmonary Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ming-Ju Hsieh
- Chang Gung University, Taiwan; Department of Surgery, Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yun-Hen Liu
- Chang Gung University, Taiwan; Department of Surgery, Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ching-Yang Wu
- Chang Gung University, Taiwan; Department of Surgery, Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.
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He R, Ming C, Lei Y, Chen W, Ye L, Li G, Zhang X, Jiang B, Zeng T, Huang Y, Zhao G. Preoperative pulmonary nodule localization: A comparison of hook wire and Lung-pro-guided surgical markers. Clin Respir J 2024; 18:e13726. [PMID: 38118458 PMCID: PMC10775885 DOI: 10.1111/crj.13726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/20/2023] [Accepted: 12/06/2023] [Indexed: 12/22/2023]
Abstract
In minimally invasive thoracoscopic surgery, for solitary pulmonary nodules (SPNs) far from the pleura, it is difficult to resected by only relying on imaging data, and effective preoperative localization can significantly improve the success rate of surgery. Therefore, preoperative localization is particularly important for accurate resection. Here, we compare the value of a novel Lung-pro-guided localization technique with Hook-wire localization in video-assisted thoracoscopic surgery. METHOD In this study, 70 patients who underwent CT-guided Hook-wire localization and Lung-pro guided surgical marker localization before VATS-based SPNs resection between May 2020 and March 2021 were analyzed, and the clinical efficacy and complication rate of the two groups were compared. RESULT Thirty-five patients underwent Lung-pro guided surgical marker localization, and 35 patients underwent CT-guided Hook-wire localization. The localization success rates were 94.3% and 88.6%, respectively (p = 0.673). Compared with the puncture group, the locating time in the Lung-pro group was significantly shorter (p = 0.000), and the wedge resection time was slightly shorter than that in the puncture group (P = 0.035). There were no significant differences in the success rate of localization, localization complications, intraoperative blood loss, postoperative hospital stay, and the number of staplers used. CONCLUSION The above studies show that the Lung-pro guided surgical marker localization and the CT-guided Hook-wire localization have shown good safety and effectiveness. However, the Lung-pro guided surgical marker localization may show more safety than the Hook-wire and can improve the patient's perioperative experience.
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Affiliation(s)
- Rui He
- Department of Thoracic Surgery IThird Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital, Yunnan Cancer Center)KunmingChina
| | - Chao Ming
- Department of Thoracic Surgery IThird Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital, Yunnan Cancer Center)KunmingChina
| | - Yujie Lei
- Department of Thoracic Surgery IThird Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital, Yunnan Cancer Center)KunmingChina
| | - Wanling Chen
- Department of Thoracic Surgery IThird Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital, Yunnan Cancer Center)KunmingChina
| | - Lianhua Ye
- Department of Thoracic Surgery IThird Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital, Yunnan Cancer Center)KunmingChina
| | - Guangjian Li
- Department of Thoracic Surgery IThird Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital, Yunnan Cancer Center)KunmingChina
| | - Xiangwu Zhang
- Department of Thoracic Surgery IThird Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital, Yunnan Cancer Center)KunmingChina
| | - Boyi Jiang
- Department of Thoracic Surgery IThird Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital, Yunnan Cancer Center)KunmingChina
| | - Teng Zeng
- Department of Thoracic Surgery IThird Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital, Yunnan Cancer Center)KunmingChina
| | - Yunchao Huang
- Department of Thoracic Surgery IThird Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital, Yunnan Cancer Center)KunmingChina
| | - Guangqiang Zhao
- Department of Thoracic Surgery IThird Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital, Yunnan Cancer Center)KunmingChina
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Nasner D, Mejía-Quiñones V, Velásquez-Galvis M, Toro-Gutiérrez JS. CT-guided harpoon marking a ground-glass infiltrate: A case report. Radiol Case Rep 2023; 18:4479-4484. [PMID: 37868013 PMCID: PMC10585181 DOI: 10.1016/j.radcr.2023.09.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 10/24/2023] Open
Abstract
Physicians are facing a growing challenge in characterizing suspicious pulmonary lesions through biopsy. Video thoracoscopic surgery is crucial for conducting surgical biopsies of these nodules. However, accurately identifying small pulmonary nodules, tiny, subsolid, and deep ones, remains a significant challenge due to the absence of digital palpation. One proposed technique for localization involves using a harpoon, initially designed for mammary nodules but also applied to pulmonary nodules. In cases involving solitary pulmonary nodules, histologic characterization is often necessary also accurate descriptions through computed tomography and the patient's clinical and epidemiologic context allow for a presumptive diagnosis. In this case, during an abdominal CT scan, a 49-year-old female patient was serendipitously found to have a ground-glass infiltrate in the anteromedial segment of the lower lobe of her left lung. Despite presenting with normal lung auscultation on physical examination, the increasing prevalence of subsolid lung nodules, combined with the contemporary era of minimally invasive surgery, prompted the medical team to employ CT-guided harpoon marking for precise lesion localization. Subsequent pathology analysis confirmed the presence of lepidic pattern adenocarcinoma. This case underscores the efficacy of the CT-guided harpoon marking approach, which significantly enhances surgical precision. Such precision is paramount in formulating individualized treatment strategies and follow-up plans for patients with similar clinical presentations.
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Affiliation(s)
- Daniela Nasner
- Clinical Research Center, Fundación Valle del Lili, Cali, Colombia
| | - Valentina Mejía-Quiñones
- Clinical Research Center, Fundación Valle del Lili, Cali, Colombia
- Faculty of Health Sciences, School of Medicine, Universidad Icesi, Cali, Colombia
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Song J, He Y, Zhong T, Liu Q, Zhou Y, Sun F. Preoperative Localization for Small Pulmonary Nodules Using Anchor with Scaled Suture System. Cardiovasc Intervent Radiol 2022. [PMID: 36229696 DOI: 10.1007/s00270-022-03291-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 09/24/2022] [Indexed: 11/02/2022]
Abstract
PURPOSES This study aimed to describe a new localization technique developed using an anchor with a scaled suture (AWSS) system and to characterize the localization results and post-operative outcomes to evaluate its safety and effectiveness. METHODS This retrospective study was conducted at our centre from October 2020 to December 2021. In total, 328 small pulmonary nodules (sPNs) who underwent pre-operative computed tomography (CT)-guided AWSS system localization followed by wedge resection by video-assisted thoracoscopic surgery (VATS) were enrolled in this study. RESULTS CT-guided AWSS system implantations targeting 328 sPNs were successfully performed. The time spent performing localization was 12.4 ± 4.9 min. After puncture localization, the incidences of pneumothorax, pulmonary haemorrhage, and chest pain were 19.2% (63/328), 25.9% (85/328), and 0.9% (3/328), respectively. The incidence of overall complications was 42.7%. According to the CIRSE classification, there were no major complications. The median localization-VATS interval time was 7 h (range, 1-75 h). In 328 cases (100%), the location of the lesion was determined by palpation of the four-paw anchor in the lung and was successfully resected by VATS, and the correct diagnosis was obtained. CONCLUSION In this series, CT-guided pre-operative localization of pulmonary nodules with the AWSS system was safe and had a high positioning accuracy and success rate.
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Gkikas A, Lampridis S, Patrini D, Kestenholz PB, Scarci M, Minervini F. How effective is indocyanine green (ICG) in localization of malignant pulmonary nodules? A systematic review and meta-analysis. Front Surg 2022; 9:967897. [PMID: 35959126 PMCID: PMC9357917 DOI: 10.3389/fsurg.2022.967897] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/11/2022] [Indexed: 12/24/2022] Open
Abstract
BackgroundVideo-Assisted and Robotic-Assisted techniques become constantly more prominent practice in thoracic surgery for lung cancer. Furthermore, the increased frequency in detection of small lung cancers makes the intra-operative identification of these cancers even more challenging. Indocyanine Green (ICG) is one of the most commonly used dyes that assists surgeons identify small lung cancers intra-operatively. Our study aimed to evaluate the effectiveness and safety of ICG in lung cancer detection.MethodsWe performed a systematic review of the literature by screening the databases of MEDLINE, EMBASE, CENTRAL and Scopus until 30th April 2022 and the first 300 articles of Google Scholar for any suitable grey literature. We included any study that investigated the effectiveness of ICG in lung cancer detection. We excluded studies that explored the use of ICG only in identification of intersegmental planes, lymph node mapping, case reports and non-English articles. We aimed to perform a meta-analysis on test accuracy studies using hierarchical summary receiver operating characteristic (HSROC) and the bivariate random-effects models. In cases where the data for a localization technique was not sufficient for that analysis, it was presented with tables with narrative purposes. Each study was assessed for Risk of Bias (RoB) and Applicability using the QUADAS-2 tool.ResultsWe found 30 eligible studies that included a total of 1,776 patients who underwent ICG localization of pulmonary nodules. We identified three ICG localization techniques: CT-guided, endobronchial and intravenous. From the 30 studies, 13 investigated CT-guided localization, 12 explored an endobronchial method while 8 studies administered ICG intravenously the median reported success rate was 94.3% (IQR: 91.4%–100%) and 98.3% (IQR: 94%–100%) for the first two techniques respectively. Intravenous ICG lung cancer localization showed Sensitivity of 88% (95% CI: 59%–0.97%) and Specificity of 25% (95% CI: 0.04%–0.74%). There were 15.2% (150/989) patients who experienced complications from CT guided ICG localization. No ICG-related complications were reported in endobronchial or intravenous techniques.ConclusionOur study provides a comprehensive review of the literature on ICG localization techniques for lung cancer. Current evidence suggests that ICG is boh effective and safe. Further prospective research with standardized protocols across multiple thoracic units is required in order to accurately validate these findings.
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Affiliation(s)
- Andreas Gkikas
- Department of General Surgery, Hillingdon Hospital, The Hillingdon Hospitals NHS Foundation Trust, London, United Kingdom
| | - Savvas Lampridis
- Department of Thoracic Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Davide Patrini
- Department of Thoracic Surgery, University College London Hospitals, London, United Kingdom
| | - Peter B. Kestenholz
- Department of Thoracic Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Marco Scarci
- Department of Thoracic Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Fabrizio Minervini
- Department of Thoracic Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
- Correspondence: Fabrizio Minervini
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Tsoumakidou G, Saltiel S, Villard N, Duran R, Meuwly JY, Denys A. Image-guided marking techniques in interventional radiology: A review of current evidence. Diagn Interv Imaging 2021; 102:699-707. [PMID: 34419388 DOI: 10.1016/j.diii.2021.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/05/2021] [Accepted: 07/19/2021] [Indexed: 12/18/2022]
Abstract
Precise marking of lesions using image-guided techniques is essential, as imprecise targeting of a tumor can result in either insufficient excision/treatment with an increased risk of recurrence, or excessive removal of healthy tissue. Most frequent indications include localization of nonpalpable lesions before surgical resection (i.e., hook-wire localization of pulmonary nodules before video-assisted thoracoscopy) and definite marking of liver metastasis before neoadjuvant therapy. Other indications include marking of hepatocellular carcinomas that are not visible on ultrasound and unenhanced computed tomography before thermal ablation, of bone lesions before surgical excision, and of different visceral tumors before stereotactic radiotherapy. This review presents the different existing indications, assesses their usefulness, gives systematic details on the technique and lastly analyzes the current literature with emphasis on results and complications.
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Affiliation(s)
| | - Sarah Saltiel
- Department of Radiology, CHUV, CH-1011, Lausanne, Switzerland
| | - Nicolas Villard
- Department of Radiology, CHUV, CH-1011, Lausanne, Switzerland
| | - Rafael Duran
- Department of Radiology, CHUV, CH-1011, Lausanne, Switzerland
| | | | - Alban Denys
- Department of Radiology, CHUV, CH-1011, Lausanne, Switzerland
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Munetomo K, Matsui Y, Iguchi T, Hiraki T, Yamamoto H, Toyooka S, Kanazawa S. Lung Laceration Caused by Short Hookwire Placement Before Video-Assisted Thoracoscopic Surgery. Cardiovasc Intervent Radiol 2020; 44:339-341. [PMID: 33078237 DOI: 10.1007/s00270-020-02662-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/18/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Kazuaki Munetomo
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Yusuke Matsui
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan.
| | - Toshihiro Iguchi
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Takao Hiraki
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Hiromasa Yamamoto
- Department of General Thoracic Surgery, Okayama University Medical School, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan
| | - Shinichi Toyooka
- Department of General Thoracic Surgery, Okayama University Medical School, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
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