Abstract
BackgroundTo evaluate the feasibility and safety of microcoil in simultaneous localization for multiple pulmonary nodules before video-assisted thoracic surgery (VATS).MethodsTwenty-eight consecutive patients (26 two-nodule, 2 three-nodule; 58 nodules in total; Group A) underwent simultaneous CT-guided localization of multiple pulmonary nodules before VATS using microcoil. Successful targeting, localization, and VATS were defined as implantation of microcoil at the target site on CT image which was obtained immediately after the marking procedure, visualization of nodule location, and complete resection of the target nodule with adequate margin, respectively. Meanwhile, the clinical characteristics, localization procedure-related variables of the nodules and procedure-related complications in group A were also assessed and compared with those in a control group (221 single-localization procedures in 221 patients; Group B).ResultsSimilar rates of successful targeting, localization and VATS were observed in group A and B (96.6% vs. 98.2%; 91.4% vs. 91.0%; 100% vs. 99.1%). Although the rate of overall complications (including localized pneumothorax and intrapulmonary hemorrhage) was a bit higher in group A than that in group B (32.8% vs. 30.8%, p = 0.771), only minor complications were observed in the subjects of the two groups with no need for further treatment. In addition, the duration of simultaneous localization procedures was significantly longer than that of single localization (24 ± 7.5 vs.13 ± 6 min, p < 0.001).ConclusionsCT-guided simultaneous microcoil localization for multiple pulmonary nodules before VATS was clinically feasible and safe with acceptable increase in the procedure time. Compared with localization for a single pulmonary nodule, simultaneous microcoil localizations for multiple nodules were prone to pneumothorax and hemorrhage. However, no statistically significant differences were observed between the two groups.
Highlights
To evaluate the feasibility and safety of microcoil in simultaneous localization for multiple pulmonary nodules before video-assisted thoracic surgery (VATS)
The successful targeting, localization, and VATS rate for group A and B For group A, according to the CT scan obtained immediately after the marking procedure, two microcoils which were implanted on the pleural surface and did not reach the target parenchymal regions, the successful targeting rate was 96.6% (56/58).Three microcoils dislodged into the thoracic cavity after initial deflation of the lung, the successful localization rate was 91.4% (53/58)
For group B, four microcoils did not reach the target parenchymal region on CT scan and repeated punctures were performed immediately, the initial successful targeting rate was 98.2% (217/221). 12 microcoils dislodged into the thoracic cavity, 3 adhered to the parietal pleural and 1 fell on the diaphragmatic surface when the target lung collapsed, the successful localization rate was 91.0% (201/221)
Summary
To evaluate the feasibility and safety of microcoil in simultaneous localization for multiple pulmonary nodules before video-assisted thoracic surgery (VATS). Owing to the worldwide concerns about lung cancer screening and the improvement of imaging modalities, the detection of small pulmonary nodules is increasing, especially the rate of simultaneous multiple nodules in a single patient [1, 2]. CT-guided microcoil localization of pulmonary nodule before video-assisted thoracic surgery (VATS) has been considered as a safe and accurate technique with a high success rate and low complication rate [5,6,7,8,9,10,11,12,13,14]. Considering the procedure time, possible changes in body position, potential morbidity and complications, it is still a challenge to perform simultaneous localization of multiple nodules in one procedure
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