Preoperative radio-guided localization of lung nodules with I-125 seeds: experience with 32 patients at a single institution.

Sara Fra-Fernández,Alberto Cabañero-Sánchez,Luis Gorospe-Sarasúa,Gemma María Muñoz-Molina,Percy Enrique Serrano-Carvajal,Nicolás Moreno-Mata,Odile Ajuria-Illarramendi,Maria Eugenia Rioja-Martin

doi:10.1093/icvts/ivab223

Abstract

Videothoracoscopic visualization and/or palpation of pulmonary nodules may be difficult due to their location, small size or limited solid component. The purpose of this study is to present our experience with computed tomography (CT)-guided preoperative localization of pulmonary nodules by percutaneous marking with radio-labelled iodine-125 seeds. A total of 34 pulmonary nodules were marked under CT with the placement of 33 radio-labelled iodine-125 seeds in 32 consecutive patients. All patients underwent biportal video-assisted thoracic surgery (VATS) and in no case was conversion to thoracotomy necessary. A total of 88.2% of the lung nodules were successfully resected. In the remaining 11.8%, migration of the seed to the pleural cavity occurred, although these nodules were still resected during VATS. Of all the patients with pneumothorax after the marking procedure, only one required chest tube placement (3.1%). No major postoperative complications were observed. Preoperative marking of pulmonary nodules with I-125 seeds under CT guidance is a feasible and safe technique that allows their intraoperative identification and resection.

Highlights

Video-assisted thoracic surgery (VATS) has become a very useful tool in the diagnostic and therapeutic management of lung lesions [1]
In the remaining 11.8%, migration of the seed to the pleural cavity occurred, these nodules were still resected during VATS
The increasing detection rate of pulmonary nodules as a consequence of the implementation of low-dose radiation chest computed tomography (CT) studies within the framework of lung cancer screening programs [2,3,4] and the growing indication for pulmonary metastasectomies [5] have led to an increased demand of resection of small nodules by VATS

Summary

Introduction

Video-assisted thoracic surgery (VATS) has become a very useful tool in the diagnostic and therapeutic management of lung lesions [1]. Thoracoscopic identification (visualization and/or palpation) of some pulmonary lesions may be difficult due to their location, small size or scant solid component. For this reason, several techniques have been developed to facilitate the intraoperative localization and optimal resection of non-palpable and/or non-visible lung nodules [6, 7]. Several techniques have been developed to facilitate the intraoperative localization and optimal resection of non-palpable and/or non-visible lung nodules [6, 7] These techniques include the use of hookwires (guidewires) [8, 9], coils [10, 11], fiducial markers, various dye-markings [12, 13] or injection of different liquid radiotracers [14, 15]. The objective of this study is to describe our experience with this localization technique at our institution

Objectives

Methods

Results

Conclusion