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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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Cumulative distributions of stain-lesion distance for lesions on middle/upper versus those on lower lobes.
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Figure 7: Cumulative distributions of stain-lesion distance for lesions on middle/upper versus those on lower lobes.

Mentions: Table 2 shows the stain-lesion distances and successful localization rates by location and pathological diagnosis. There was no significant difference in stain-lesion distance between left and right lungs. The stain-lesion distances were not dependent on the type of histological diagnosis, lesion sizes, age and sex. The lower lobes had a significantly longer stain-lesion distance than upper and middle lobes with a crude average of 3.0 (95% CI: 1.6, 4.3) mm (p<0.001). Further controlling for age, sex, lesion size and pathological diagnosis using the multiple linear regression method, the adjusted difference between lower and upper/middle lobes in stain-lesion distance remained statistically significant with a mean of 3.0 (95% CI: 1.7, 4.4), p<0.001. However, about 80% stain-lesion distances were<5 mm for lesions on middle/upper lobes while 80% stain-lesion distances were <10 mm for lesions on the lower lobes (Figure 7). The successful localization rate was 98% (95% CI: 90, 100) for lesions in upper or middle lobes, which was significantly higher than that for lesions in lower lobes (86%), p=0.036. There were no significant differences in the successful localization rate or stain-lesion difference between left and right lungs and between benign and malignant lesions.


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)

Cumulative distributions of stain-lesion distance for lesions on middle/upper versus those on lower lobes.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 7: Cumulative distributions of stain-lesion distance for lesions on middle/upper versus those on lower lobes.
Mentions: Table 2 shows the stain-lesion distances and successful localization rates by location and pathological diagnosis. There was no significant difference in stain-lesion distance between left and right lungs. The stain-lesion distances were not dependent on the type of histological diagnosis, lesion sizes, age and sex. The lower lobes had a significantly longer stain-lesion distance than upper and middle lobes with a crude average of 3.0 (95% CI: 1.6, 4.3) mm (p<0.001). Further controlling for age, sex, lesion size and pathological diagnosis using the multiple linear regression method, the adjusted difference between lower and upper/middle lobes in stain-lesion distance remained statistically significant with a mean of 3.0 (95% CI: 1.7, 4.4), p<0.001. However, about 80% stain-lesion distances were<5 mm for lesions on middle/upper lobes while 80% stain-lesion distances were <10 mm for lesions on the lower lobes (Figure 7). The successful localization rate was 98% (95% CI: 90, 100) for lesions in upper or middle lobes, which was significantly higher than that for lesions in lower lobes (86%), p=0.036. There were no significant differences in the successful localization rate or stain-lesion difference between left and right lungs and between benign and malignant lesions.

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