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A new technique combining virtual simulation and methylene blue staining for the localization of small peripheral pulmonary lesions.

Shentu Y, Zhang L, Gu H, Mao F, Cai M, Ding Z, Wang Z - BMC Cancer (2014)

Bottom Line: According to pathology results, appropriate surgical procedures were decided and undertaken.Our preoperative localization procedure was successful in 75 of 80 (94%) lesions.The novel technique combining the preoperative virtual simulation and methylene blue staining techniques has a high success rate for localizing small peripheral pulmonary lesions, particularly for those tiny lesions which are difficult to visualise and palpate during VATS.

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Medicine, University of Queensland, QLD 4029 Queensland, Australia. z.wang@uq.edu.au.

ABSTRACT

Background: Quickly and accurately localizing small peripheral pulmonary lesions can avoid prolonged operative time and unplanned open thoracotomy. In this study, we aimed to introduce and evaluate a new technique combining virtual simulation and methylene blue staining for the localization of small peripheral pulmonary lesions.

Methods: Seventy four (74) patients with 80 peripheral pulmonary lesions <20 mm in size on computer tomography (CT) were virtually punctured using a radiotherapy planning simulator on the day before operation. Under general anaesthesia, methylene blue dye was injected to the virtually identified point according to the surface point, angle and depth previously determined by the simulator. The wedge resection of the marked lesion was performed under video-assisted thoracoscopic surgery (VATS) and the specimens were sent for immediate pathologic examination. According to pathology results, appropriate surgical procedures were decided and undertaken.

Results: The average lesion size was 10.4±3.5 mm (range: 4-17 mm) and the average distance to the pleural surface was 9.4±4.9 mm. Our preoperative localization procedure was successful in 75 of 80 (94%) lesions. Histological examination showed 28 benign lesions and 52 lung cancers. The shortest distance between the edges of the stain and lesion was 5.1±3.1 mm. Localization time was 17.4±2.3 min. All patients with malignant lesions subsequently underwent lobectomy and systematic lymph node dissection. No complications were observed in all participants.

Conclusions: The novel technique combining the preoperative virtual simulation and methylene blue staining techniques has a high success rate for localizing small peripheral pulmonary lesions, particularly for those tiny lesions which are difficult to visualise and palpate during VATS.

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Related in: MedlinePlus

Image generated using radiation therapy planning system based on images and data collected from previous CT scan.
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Figure 2: Image generated using radiation therapy planning system based on images and data collected from previous CT scan.

Mentions: 2) Image transferring and simulation data for virtual puncturing: The CT images generated in the Department of Radiology were transferred to the Department of Radiotherapy in our hospital, in which an injection plan was developed using the radiation therapy planning system, Phillips-Pinncle 3 (Philips Healthcare). This system was originally designed for developing radiation therapy and we used the various parameters generated from this system for a different purpose: localizing lesions. According to the CT images, the system software calculated the direction and depth of the radiation beam to the lesion. It also calculated the distance between skin surface to the lesion and the distance from the edge of the lesion to the pleural surface. For our purpose, we envisaged that the injection needle could act as a beam and follow the direction of the beam to reach the targeted lesion according to the distance from skin surface to the lesion calculated by the system. For each lesion, the system provided various entry points and angles. We chose the point with either vertical or horizontal angle to minimize operational difficulties and errors (Figure 2). The simulated virtual data for puncturing were recorded for the next step.


A new technique combining virtual simulation and methylene blue staining for the localization of small peripheral pulmonary lesions.

Shentu Y, Zhang L, Gu H, Mao F, Cai M, Ding Z, Wang Z - BMC Cancer (2014)

Image generated using radiation therapy planning system based on images and data collected from previous CT scan.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3926337&req=5

Figure 2: Image generated using radiation therapy planning system based on images and data collected from previous CT scan.
Mentions: 2) Image transferring and simulation data for virtual puncturing: The CT images generated in the Department of Radiology were transferred to the Department of Radiotherapy in our hospital, in which an injection plan was developed using the radiation therapy planning system, Phillips-Pinncle 3 (Philips Healthcare). This system was originally designed for developing radiation therapy and we used the various parameters generated from this system for a different purpose: localizing lesions. According to the CT images, the system software calculated the direction and depth of the radiation beam to the lesion. It also calculated the distance between skin surface to the lesion and the distance from the edge of the lesion to the pleural surface. For our purpose, we envisaged that the injection needle could act as a beam and follow the direction of the beam to reach the targeted lesion according to the distance from skin surface to the lesion calculated by the system. For each lesion, the system provided various entry points and angles. We chose the point with either vertical or horizontal angle to minimize operational difficulties and errors (Figure 2). The simulated virtual data for puncturing were recorded for the next step.

Bottom Line: According to pathology results, appropriate surgical procedures were decided and undertaken.Our preoperative localization procedure was successful in 75 of 80 (94%) lesions.The novel technique combining the preoperative virtual simulation and methylene blue staining techniques has a high success rate for localizing small peripheral pulmonary lesions, particularly for those tiny lesions which are difficult to visualise and palpate during VATS.

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Medicine, University of Queensland, QLD 4029 Queensland, Australia. z.wang@uq.edu.au.

ABSTRACT

Background: Quickly and accurately localizing small peripheral pulmonary lesions can avoid prolonged operative time and unplanned open thoracotomy. In this study, we aimed to introduce and evaluate a new technique combining virtual simulation and methylene blue staining for the localization of small peripheral pulmonary lesions.

Methods: Seventy four (74) patients with 80 peripheral pulmonary lesions <20 mm in size on computer tomography (CT) were virtually punctured using a radiotherapy planning simulator on the day before operation. Under general anaesthesia, methylene blue dye was injected to the virtually identified point according to the surface point, angle and depth previously determined by the simulator. The wedge resection of the marked lesion was performed under video-assisted thoracoscopic surgery (VATS) and the specimens were sent for immediate pathologic examination. According to pathology results, appropriate surgical procedures were decided and undertaken.

Results: The average lesion size was 10.4±3.5 mm (range: 4-17 mm) and the average distance to the pleural surface was 9.4±4.9 mm. Our preoperative localization procedure was successful in 75 of 80 (94%) lesions. Histological examination showed 28 benign lesions and 52 lung cancers. The shortest distance between the edges of the stain and lesion was 5.1±3.1 mm. Localization time was 17.4±2.3 min. All patients with malignant lesions subsequently underwent lobectomy and systematic lymph node dissection. No complications were observed in all participants.

Conclusions: The novel technique combining the preoperative virtual simulation and methylene blue staining techniques has a high success rate for localizing small peripheral pulmonary lesions, particularly for those tiny lesions which are difficult to visualise and palpate during VATS.

Show MeSH
Related in: MedlinePlus