Limits...
Localization of nonpalpable pulmonary nodules using CT-guided needle puncture.

Hsu HH, Shen CH, Tsai WC, Ko KH, Lee SC, Chang H, Huang TW - World J Surg Oncol (2015)

Bottom Line: We retrospectively reviewed the clinical data, technical details, surgical findings and pathologic results, and complications associated with CT-guided localization.Fifty-seven nodules (62.63%) were confirmed as malignances, including 45 primary lung cancer, and 34 nodules (37.37%) were confirmed as benign lesions.CT-guided needle puncture can be an effective and safe procedure prior to VATS, enabling accurate resection and diagnosis of small pulmonary nodules.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.

ABSTRACT

Background: Surgical resection of small pulmonary nodule is challenging via thoracoscopic procedure. We describe our experience of computed tomography (CT)-guided needle puncture localization of indeterminate pulmonary nodules prior to video-assisted thoracoscopic surgery (VATS).

Methods: From January 2011 to July 2014, 78 consecutive patients underwent CT-guided marking for the localization of 91 small pulmonary nodules. We retrospectively reviewed the clinical data, technical details, surgical findings and pathologic results, and complications associated with CT-guided localization.

Results: Seventy-eight consecutive patients (36 men and 42 women) underwent CT-guided marking localization of 91 indeterminate pulmonary nodules (62 pure ground-glass opacity nodules, 27 part-solid nodules, and 2 solid nodules). The mean size of the nodules was 8.6 mm (3.0-23.0 mm). The mean pleural distance between the nodule and lung surface was 11.5 mm (3.0-31.3 mm). The mean procedure time of CT-guided localization was 15.2 min (8-42 min). All patients stood the procedures well without requiring conversion to open thoracotomy. Twenty-four patients (30.77%) developed pneumothorax after the procedures. Only one patient required retention of the puncture needle introducer for air drainage. The mean visual assessment pain score was 1.7 (0-3). Fifty-seven nodules (62.63%) were confirmed as malignances, including 45 primary lung cancer, and 34 nodules (37.37%) were confirmed as benign lesions.

Conclusions: CT-guided needle puncture can be an effective and safe procedure prior to VATS, enabling accurate resection and diagnosis of small pulmonary nodules.

No MeSH data available.


Related in: MedlinePlus

a The puncture needle (Temno Coaxial Introducer Needle, Care Fusion, PP1910) was inserted under the CT-guided imaging. b Intraoperative identification of the puncture holes at lung surface after one lung ventilation
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4536773&req=5

Fig1: a The puncture needle (Temno Coaxial Introducer Needle, Care Fusion, PP1910) was inserted under the CT-guided imaging. b Intraoperative identification of the puncture holes at lung surface after one lung ventilation

Mentions: The patient was transferred to the CT room before operation. A CT scan was performed to confirm the presence of nodules before the localization procedure. After 2 % lidocaine local injection into the puncture site of the chest wall, the introducer for a 17-gauge puncture needle (Temno Coaxial Introducer Needle PP1910, CareFusion) was inserted under CT guidance. When the introducer was inserted into the lung parenchyma (Fig. 1a) (near the lesion, but without directly puncturing the lesion to avoid tumor seeding via a puncture tract), a CT scan confirmed the location of the introducer. The needle was then inserted via the introducer. All procedures were performed by experienced radiologists (H.H.H. and K.H.K.). Afterward, the patient was transferred to the operating room. Patient positioning and preparation were the same as standard VATS. All thoracoscopic procedures were performed under general anesthesia with selective intubation through a double lumen tube to obtain ipsilateral lung collapse. The patients were placed in a lateral decubitus position. In all patients, an 11.5-mm trocar for thoracoscopy was inserted into the seventh intercostal space along the mid-axillary line. After an exploration of the pleural space, a second 11.5-mm trocar was placed according to the need for strategic visibility of the target lesion. After identification of the puncture holes (Fig. 1b), wedge resection of the target lesion was performed using an Endo-GIA™ Universal Stapler. The specimen was examined by a pathologist as a frozen section. The operations were terminated after the report of the pathological results as benign lesions. For primary lung cancer, anatomic resection and mediastinal lymph node dissection were done. We evaluated the clinicopathological data, procedure-related parameters, and complications.Fig. 1


Localization of nonpalpable pulmonary nodules using CT-guided needle puncture.

Hsu HH, Shen CH, Tsai WC, Ko KH, Lee SC, Chang H, Huang TW - World J Surg Oncol (2015)

a The puncture needle (Temno Coaxial Introducer Needle, Care Fusion, PP1910) was inserted under the CT-guided imaging. b Intraoperative identification of the puncture holes at lung surface after one lung ventilation
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4536773&req=5

Fig1: a The puncture needle (Temno Coaxial Introducer Needle, Care Fusion, PP1910) was inserted under the CT-guided imaging. b Intraoperative identification of the puncture holes at lung surface after one lung ventilation
Mentions: The patient was transferred to the CT room before operation. A CT scan was performed to confirm the presence of nodules before the localization procedure. After 2 % lidocaine local injection into the puncture site of the chest wall, the introducer for a 17-gauge puncture needle (Temno Coaxial Introducer Needle PP1910, CareFusion) was inserted under CT guidance. When the introducer was inserted into the lung parenchyma (Fig. 1a) (near the lesion, but without directly puncturing the lesion to avoid tumor seeding via a puncture tract), a CT scan confirmed the location of the introducer. The needle was then inserted via the introducer. All procedures were performed by experienced radiologists (H.H.H. and K.H.K.). Afterward, the patient was transferred to the operating room. Patient positioning and preparation were the same as standard VATS. All thoracoscopic procedures were performed under general anesthesia with selective intubation through a double lumen tube to obtain ipsilateral lung collapse. The patients were placed in a lateral decubitus position. In all patients, an 11.5-mm trocar for thoracoscopy was inserted into the seventh intercostal space along the mid-axillary line. After an exploration of the pleural space, a second 11.5-mm trocar was placed according to the need for strategic visibility of the target lesion. After identification of the puncture holes (Fig. 1b), wedge resection of the target lesion was performed using an Endo-GIA™ Universal Stapler. The specimen was examined by a pathologist as a frozen section. The operations were terminated after the report of the pathological results as benign lesions. For primary lung cancer, anatomic resection and mediastinal lymph node dissection were done. We evaluated the clinicopathological data, procedure-related parameters, and complications.Fig. 1

Bottom Line: We retrospectively reviewed the clinical data, technical details, surgical findings and pathologic results, and complications associated with CT-guided localization.Fifty-seven nodules (62.63%) were confirmed as malignances, including 45 primary lung cancer, and 34 nodules (37.37%) were confirmed as benign lesions.CT-guided needle puncture can be an effective and safe procedure prior to VATS, enabling accurate resection and diagnosis of small pulmonary nodules.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.

ABSTRACT

Background: Surgical resection of small pulmonary nodule is challenging via thoracoscopic procedure. We describe our experience of computed tomography (CT)-guided needle puncture localization of indeterminate pulmonary nodules prior to video-assisted thoracoscopic surgery (VATS).

Methods: From January 2011 to July 2014, 78 consecutive patients underwent CT-guided marking for the localization of 91 small pulmonary nodules. We retrospectively reviewed the clinical data, technical details, surgical findings and pathologic results, and complications associated with CT-guided localization.

Results: Seventy-eight consecutive patients (36 men and 42 women) underwent CT-guided marking localization of 91 indeterminate pulmonary nodules (62 pure ground-glass opacity nodules, 27 part-solid nodules, and 2 solid nodules). The mean size of the nodules was 8.6 mm (3.0-23.0 mm). The mean pleural distance between the nodule and lung surface was 11.5 mm (3.0-31.3 mm). The mean procedure time of CT-guided localization was 15.2 min (8-42 min). All patients stood the procedures well without requiring conversion to open thoracotomy. Twenty-four patients (30.77%) developed pneumothorax after the procedures. Only one patient required retention of the puncture needle introducer for air drainage. The mean visual assessment pain score was 1.7 (0-3). Fifty-seven nodules (62.63%) were confirmed as malignances, including 45 primary lung cancer, and 34 nodules (37.37%) were confirmed as benign lesions.

Conclusions: CT-guided needle puncture can be an effective and safe procedure prior to VATS, enabling accurate resection and diagnosis of small pulmonary nodules.

No MeSH data available.


Related in: MedlinePlus