Tomography-guided Localization Research Articles

Preoperative Computed Tomography-Guided Localization of Ground-Glass Opacities With Metallic Clip

Intraoperative localization of ground-glass opacities is difficult because they are not easy to palpate and may be invisible at radioscopy. Therefore, various techniques have been developed to improve intraoperative localization of these lesions, allowing an adequate surgical resection. The aim of this study is to report two cases of preoperative localization of ground-glass opacities through computed tomography-guided placement of a metallic clip inside the lesion and to discuss this new technique in comparison with those previously described.

Fluoroscopy-Assisted Thoracoscopic Resection for Small Intrapulmonary Lesions after Preoperative Computed Tomography-Guided Localization Using Fragmented Platinum Microcoils

Preoperative localization is frequently necessary to perform thoracoscopic resection of a small and/or deeply located intrapulmonary lesion. We developed a new method that uses a fragmented platinum microcoil, and retrospectively evaluated the efficacy of our technique. Between January 2006 and May 2010, self-made microcoils (Easimarker) were used to localize total 32 lesions (21 solid nodules, and 11 ground glass opacities) in 30 patients. Computed tomography-guided localization was performed into, or just around the lesions. Localized lesions were resected using fluoroscopy-assisted thoracoscopic surgery (FATS), and the histopathologic diagnosis was confirmed. The accuracy and complications of the localization procedure, and operative results of FATS were observed. Mean size and depth of all lesions were 11.8 ± 5.1 mm (range: 3 to 22) and 12.2 ± 7.1 mm (range: 2 to 30). CT-guided localizations were successfully performed in all lesions. Four minimal pneumothorax and one parenchymal hematoma related with localization procedure occurred. There were three repeated procedures, which resulted from pleural rebounding of the microcoils. There were two microcoil detecting failures due to intrathoracic displacement during FATS. All 32 resected lesions were histopathologically diagnosed. CT-guided localization using the fragmented microcoil combined with FATS of small intrapulmonary lesions is a safe, effective, and a diagnostically accurate procedure.

Abstract No. 254: Video-assisted thoracoscopic resection of ground-glass pulmonary nodules after computed tomography-guided localization with a hook-wire system

The purpose of this study was to assess the safety and effectiveness of CT-guided placement of a hook-wire system used to guide video-assisted thoracoscopic surgical (VATS) excision of impalpable GGNs, with successful excision as the primary outcome and successful CT-guided hook-wire placement and procedural complications as secondary outcomes. The institutional review board approved the study protocol. Informed consent was obtained from all 50 enrolled patients (13 men, 37 women; mean age, 55.0 years ± 8.9 [standard deviation]) with 53 nodules. Under local anesthesia and CT control, 50 patients underwent the positioning of a hook-wire system into the lung, with the hook located close to or inside the nodule to be resected. Then the patients underwent video-assisted thoracoscopic surgery resection of the nodules, and the hook-wire was performed with fluoroscopic guidance. Fifty-two (98.1%) 5.1-34.2-mm nodules were successfully removed at fluoroscopically guided VATS excision; one nodules (1.9%) could not be removed. CT-guided hook-wire placement was successful in all cases; however, one (1.9%) of 53 hook-wires were displaced at VATS excision. Pneumothorax requiring chest tube placement and asymptomatic hemothorax not occurred in all patients. The hook-wire did not impede intraoperative frozen-section histopathologic analysis, which facilitated accurate clinical management in all patients. Hook-wire localization of GGNs enabled fluoroscopically guided VATS resection of 98% of the nodules, without intervention for procedural complications.

The Application of Computed Tomography-Guided Hook-Wire Localization to Facilitate Resection of Small or Deep-seated Pulmonary Lesions Through Video-Assisted Thoracoscopic Surgery (VATS)

The Application of Computed Tomography-Guided Hook-Wire Localization to Facilitate Resection of Small or Deep-seated Pulmonary Lesions Through Video-Assisted Thoracoscopic Surgery (VATS)

Need for Preoperative Computed Tomography-Guided Localization in Video-Assisted Thoracoscopic Surgery Pulmonary Resections of Metastatic Pulmonary Nodules

Preoperative localization of pulmonary nodules is sometimes necessary when they are too small or distant from the surface of the visceral pleura to be detected during video-assisted thoracoscopic surgery. This study aims to present the criteria for localization and to evaluate the accuracy of the criteria. From April 2001 to March 2008, 178 patients with 224 nodules who underwent wedge resection of pulmonary metastatic nodules by video-assisted thoracoscopic surgery were reviewed retrospectively. Thirty-one patients (17.4%) including 35 nodules underwent thoracoscopic resection immediately after computed tomography-guided localization using hook wires. Criteria for preoperative localization were (1) maximum diameter of the nodule of 5 mm or less, (2) maximum diameter to minimum distance between the visceral pleura and inferior border of nodule of 0.5 or less, and (3) nodule with low-density image by computed tomography after chemotherapy. The accuracy of these inclusion criteria was statistically evaluated. All 224 nodules were removed by wedge resection or additional segmentectomy. Nineteen nodules (54.3%) were detected in the thoracic cavity with preoperative localization. Sensitivity, specificity, positive predictive value, and negative predictive value were 11.1%, 99.5%, 66.7%, and 92.8%; 88.9%, 93.2%, 53.3%, and 99.0%; and 88.9%, 90.8%, 45.7%, and 98.9% in each preoperative finding of which a nodule met all (3 nodules), two or more (30 nodules), and one or more (35 nodules) of the three criteria, respectively. This study suggests that preoperative localization should be considered before video-assisted thoracoscopic surgery operation if the pulmonary nodule meets two or more of our criteria.

Computed tomography-guided localization of breast lesions

Magnetic resonance (MR) imaging and computed tomography (CT) of the breast allow the detection of breast lesion occult on physical examination, mammography, and ultrasound. We report our experience to localize such lesions under CT guidance. Thirty patients underwent 30 CT-guided preoperative localizations of breast lesions using a sequential technique or a continuous imaging. All these lesions were initially detected by MR (n=11) and/or CT (n=19) and were occult for all the other techniques. In eight patients with a superficial and/or internal lesion, a skin location using a painting pen was performed.

Computed Tomography-Guided Localization of Breast Lesions

Magnetic resonance (MR) imaging and computed tomography (CT) of the breast allow the detection of breast lesions occult on physical examination, mammography and ultrasound. We report our experience to localize such lesions under CT-guidance. 30 patients underwent 30 CT-guided preoperative localizations of breast lesions using a sequential technique or a continuous imaging. All these lesions were initially detected by MR (n = 11) and/or CT (n = 19) and were occult for all the other techniques. In eight patients with a superficial and/or internal lesion, a skin location using a painting pen was performed. In the 23 other cases, the extremity of a hookwire was placed into the lesion or within 5 mm surrounding the target. All the lesions were localized with success under CT-guidance. The pathological analysis of the surgical specimens concluded in 11 breast cancers, four lesions of uncertain malignancy potential and 15 benign lesions. The size of these lesions ranged from 4 to 28 mm (mean: 10 mm). No significant complication related to the procedure was observed. Localization under CT guidance is a safe and effective technique to guide the surgical biopsy of breast lesions that can be seen solely on MR or CT.

Innovative use of a Hawkins III breast localization hookwire in preoperative computed tomography-guided localization of renal bed tumour recurrence

Innovative use of a Hawkins III breast localization hookwire in preoperative computed tomography-guided localization of renal bed tumour recurrence

Computed Tomography-Guided Needle Localization of Suspicious Breast Lesions

Non-palpable breast lesions, suspicious for carcinoma, are usually localized prior to biopsy using standard mammographic techniques. We report two patients in whom computed tomography was used to localize suspicious non-palpable breast lesions that could not be readily localized using standard mammographic techniques.