Abstract No. 565 An efficient and precise technique of preoperative pulmonary nodule localization: computer tomography-guided patent blue dye injection

Abstract

Resection of small pulmonary nodules via video assisted thoracic surgery (VATS) is usually challenging without preoperative localization. The aim of this study is to evaluate the efficacy of our experience in CT-guided preoperative localization with patent blue dye injection to facilitate thoracoscopic resection of pulmonary nodules. 125 consecutive patients underwent CT-guided localization with injection of patent blue dye between June 2015 to June 2016. The clinical and radiological characteristics, technical details, pathological results and procedure related complications were retrospectively reviewed. 125 consecutive patients (44 men and 81 women) with 137 indeterminate pulmonary nodules (46 pure ground-glass opacity nodules, 41 part-solid nodules and 50 solid nodules) were included in the study. The mean size of the nodules was 9.5 mm (3.0–22.0 mm). The mean distance between the nodule and pleural surface was 12.1 mm (2.0–42.1 mm). The mean procedure time of CT-guided localization was 16.5 min (10–50 min). The mean time interval from dye injection to operation was 188 min (range, 24–1440 min). Pneumothorax developed in forty patients (32%) and focal parenchymal hemorrhage was identified in 16 patients (12.8%) after localization. No patient required air drainage. Although non-visualization of dye marking occurred in 2 patients, focal hematoma and puncture hole can be identified on the pleural surface. Therefore, all nodules were successfully resected by VATS without conversion to open thoracotomy. 103 nodules (75.1%) were confirmed as malignancies including 87 primary lung cancer. CT-guided patent blue dye localization is an efficient technique which facilitates successful resection of small pulmonary nodules even if a long duration from localization to operation is needed.