Original article
General thoracic
Thoracoscopic Localization Techniques for Patients With Solitary Pulmonary Nodule and History of Malignancy

Presented at the Poster Session of the Fortieth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 26–28, 2004.
https://doi.org/10.1016/j.athoracsur.2004.06.012Get rights and content

Background

Our aim was to evaluate the best intrathoracoscopic localization technique in patients with single pulmonary nodule and a history of malignancy.

Methods

We divided 50 patients in two groups, well matched for diameter and depth of the pulmonary lesion. In 25 patients we performed intrathoracoscopic ultrasound to locate the pulmonary nodule (group A), whereas in the other 25 patients the radio-guided technique was adopted (group B). In both group A and group B, the localization techniques were compared with finger palpation. In group A, 12 nodules were in the left lung and 13 in the right one; in group B, 11 lesions were in the left and 14 in the right lung. In both groups, the distance of the nodule from the pleural surface was 2.6 ± 0.5 cm (2 to 2.5 cm in 14 patients, and >2.5 cm for the remaining 11). The diameter of the nodule was 1.26 ± 0.22 (≤1 cm in 10 patients, and 1 to 1.5 cm in 15) in both groups. All patients underwent thoracoscopic wedge resection, and 10 patients with a primary pulmonary lesion underwent posterior-lateral thoracotomy for lobectomy and mediastinal lymphadenectomy.

Results

In group A, ultrasound localized the nodule in 24 of 25 patients (96%) whereas finger palpation localized it in 19 of 25 (76%; not significant). In group B, both the radio-guided and finger palpation techniques localized the nodule in 20 of 25 patients (80%; not significant). No complications were recorded with the ultrasound technique; however, 10 cases of pneumothorax were detected after the radio-guided technique (p < 0.01).

Conclusions

Both the ultrasound and radio-guided techniques are accurate to detect solitary pulmonary nodules, but the radio-guided method yields complications as compared with the ultrasound.

Section snippets

Material and Methods

Between January 2001 and December 2003, 50 patients with a history of malignancy and a pulmonary nodule underwent intrathoracoscopic localization at our institution. We selected all patients with solitary pulmonary nodule and positive history of malignancy. Because we work in a general surgery unit and in our hospital there is also a thoracic surgery unit, we therefore only see patients with a history of malignancy.

We excluded all patients with nodules larger than 1.5 cm or less than 2 cm deep.

Results

In group A, the intrathoracoscopic ultrasound localized the pulmonary nodule in 24 of 25 patients (96%) and finger palpation in 19 of 25 patients (76%; not significant); in group B, both radio-guided and finger palpation techniques localized the lesion in 20 of 25 patients (80%). Although no statistical significance could be demonstrated among different localization methods, the intrathoracoscopic ultrasound seems to be superior for detecting solitary pulmonary nodules as compared with both the

Comment

Preoperative localization techniques of pulmonary nodules have been extensively studied, and their pros and cons are well established. The needle-wire technique is associated with several complications [9, 10, 11], with dislodgment of the needle being the most important one. The latter generally occurs during transportation of the patient to the operating room or during the surgical procedure, either when the lung is deflated or during the resection of the nodule, as the surgeon will often

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