Application of preoperative computed tomography-guided embolization coil localization of pulmonary nodules in thoracoscopic pulmonectomy: A randomized controlled trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HE Xiaofeng , CAO Bin , CHEN Baojun ,  SHI Minke

Department of Cardiothoracic Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, P.R.China;

Corresponding?author：

SHI Minke, Email: smk0000001@163.com

Keywords：

Embolization coil; localization; pulmonary nodules; video-assisted thoracoscopic

DOI：

10.7507/1007-4848.201612060

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To explore the diagnostic and treatment value of computed tomography (CT)-guided embolization coil localization of pulmonary nodules accurately resected under the thoracoscope. Methods Between October 2015 and October 2016, 40 patients with undiagnosed nodules of 15 mm or less were randomly divided into a no localization group (n=20, 11 males and 9 females with an average age of 60.50±8.27 years) or preoperative coil localization group (n=20, 12 males and 8 females with an average age of 61.35±8.47 years). Coils were placed with the distal end deep to the nodule and the superficial end coiled on the visceral pleural surface with subsequent visualization by video-assisted thoracoscopic (VATS). Nodules were removed by VATS wedge excision using endo staplers. The tissue was sent for rapid pathological examination, and the pulmonary nodules with definitive pathology found at the first time could be defined as the exact excision. Results The age, sex, forced expiratory volume in the first second of expiration, nodule size/depth were similar between two groups. The coil group had a higher rate of accurate resection (100.00% vs. 70.00%, P=0.008), less operation time to nodule excision (35.65±3.38 minvs. 44.38±11.53 min,P=0.003), and reduced stapler firings (3.25±0.85vs. 4.44±1.26,P=0.002) with no difference in total costs. Conclusion Preoperative CT-guided coil localization increases the rate of accurate resection.

Citation： HE Xiaofeng, CAO Bin, CHEN Baojun, SHI Minke. Application of preoperative computed tomography-guided embolization coil localization of pulmonary nodules in thoracoscopic pulmonectomy: A randomized controlled trial. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(11): 858-862. doi: 10.7507/1007-4848.201612060 Copy

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2.	Cho S, Yang H, Kim K, et al. Pathology and prognosis of persistent stable pure ground-glass opacity nodules after surgical resection. Ann Thorac Surg, 2013, 96(4):1190-1195.
3.	奚小祥, 呂必宏, 何光明, 等. 孤立性肺結節早期診治的臨床策略. 中國胸心血管外科臨床雜志, 2014, 21(6):793-798.
4.	宋勇, 姚艷雯. 肺部小結節的診斷和治療近況. 中華肺部疾病雜志(電子版), 2012, 5(4): 295-299.
5.	Zaman M, Bilal H, Woo CY, et al. In patients undergoing video-assisted thoracoscopic surgery excision, what is the best way to locate a subcentimetre solitary pulmonary nodule in order to achieve successful excision? Interact Cardiovasc Thorac Surg, 2012,15(2): 266-272.
6.	張勇, 白春學. 肺癌早期診斷進展. 中華肺部疾病雜志(電子版), 2011, 4(5): 350-355.
7.	王志強, 呂德勝, 岳世昌. 電視胸腔鏡手術在孤立性肺結節診治中的價值. 中國胸心血管外科臨床雜志, 2013(5): 607-610.
8.	Hsu HH, Shen CH, Tsai WC, et al. Localization of nonpalpable pulmonary nodules using CT-guided needle puncture. World J Surg Oncol, 2015,13: 248.
9.	Galetta D, Bellomi M, Grana C, et al. Radio-guided localization and resection of small or Ill-defined pulmonary lesions. Ann Thorac Surg, 2015,100(4):1175-1180.
10.	楊楠, 劉燦輝, 強勇, 等. 胸腔鏡下孤立性肺結節術前定位進展. 中國胸心血管外科臨床雜志, 2015, 22(7): 696-699.
11.	Jin KN, Lee KW, Kim TJ, et al. Computed tomography guided percutaneous injection of a mixture of lipiodol and methylene blue in rabbit lungs: evaluation of localization ability for video-assisted thoracoscopic surgery. J Korean Med Sci, 2014, 29(1): 129-136.
12.	Kleedehn M, Kim DH, Lee FT, et al. Preoperative Pulmonary Nodule Localization: A comparison of methylene blue and hookwire techniques. AJR Am J Roentgenol, 2016, 207(6):1334-1339.
13.	黃偉釗, 葉紅雨, 吳穎猛, 等. Hookwire 術前定位在胸腔鏡下肺部孤立性小結節切除術中的應用. 中國胸心血管外科臨床雜志, 2014, 21(1): 118-121.
14.	Ambrogi MC, Melfi F, Zirafa C, et al. Radio-guided thoracoscopic surgery (RGTS) of small pulmonary nodules. Surg Endosc, 2012, 26(4): 914-919.
15.	姜淑云, 陳煒生, 曹燕飛, 等. 計算機導航技術在肺內小結節定位中的應用. 中國胸心血管外科臨床雜志, 2009, 16(3): 226-228.
16.	Ujiie H, Kato T, Hu HP, et al. Evaluation of a new ultrasound thoracoscope for localization of lung nodules in ex vivo human lungs. Ann Thorac Surg, 2017, 103(3): 926-934.
17.	Wada H, Anayama T, Hirohashi K, et al. Thoracoscopic ultrasonography for localization of subcentimetre lung nodules. Eur J Cardiothorac Surg, 2016, 49(2): 690-697.
18.	Su TH, Fan YF, Jin L, et al. CT-guided localization of small pulmonary nodules using adjacent microcoil implantation prior to video-assisted thoracoscopic surgical resection. Eur Radiol, 2015, 25(9): 2627-2633.
19.	Donahoe LL, Nguyen ET, Chung TB, et al. CT-guided microcoil VATS resection of lung nodules: a single-centre experience and review of the literature. J Thorac Dis, 2016, 8(8): 1986-1994.
20.	Mayo JR, Clifton JC, Powell TI, et al. Lung nodules: CT-guided placement of microcoils to direct video-assisted thoracoscopic surgical resection. Radiology, 2009, 250(2): 576-585.
21.	Finley RJ, Mayo JR, Grant K, et al. Preoperative computed tomography-guided microcoil localization of small peripheral pulmonary nodules: a prospective randomized controlled trial. J Thorac Cardiovasc Surg, 2015, 149(1): 26-31.

1. Black WC, Gareen IF, Soneji SS, et al. Cost-effectiveness of CT screening in the National Lung Screening Trial. N Engl J Med,2014,371(19):1793-1802.
2. Cho S, Yang H, Kim K, et al. Pathology and prognosis of persistent stable pure ground-glass opacity nodules after surgical resection. Ann Thorac Surg, 2013, 96(4):1190-1195.
3. 奚小祥, 呂必宏, 何光明, 等. 孤立性肺結節早期診治的臨床策略. 中國胸心血管外科臨床雜志, 2014, 21(6):793-798.
4. 宋勇, 姚艷雯. 肺部小結節的診斷和治療近況. 中華肺部疾病雜志(電子版), 2012, 5(4): 295-299.
5. Zaman M, Bilal H, Woo CY, et al. In patients undergoing video-assisted thoracoscopic surgery excision, what is the best way to locate a subcentimetre solitary pulmonary nodule in order to achieve successful excision? Interact Cardiovasc Thorac Surg, 2012,15(2): 266-272.
6. 張勇, 白春學. 肺癌早期診斷進展. 中華肺部疾病雜志(電子版), 2011, 4(5): 350-355.
7. 王志強, 呂德勝, 岳世昌. 電視胸腔鏡手術在孤立性肺結節診治中的價值. 中國胸心血管外科臨床雜志, 2013(5): 607-610.
8. Hsu HH, Shen CH, Tsai WC, et al. Localization of nonpalpable pulmonary nodules using CT-guided needle puncture. World J Surg Oncol, 2015,13: 248.
9. Galetta D, Bellomi M, Grana C, et al. Radio-guided localization and resection of small or Ill-defined pulmonary lesions. Ann Thorac Surg, 2015,100(4):1175-1180.
10. 楊楠, 劉燦輝, 強勇, 等. 胸腔鏡下孤立性肺結節術前定位進展. 中國胸心血管外科臨床雜志, 2015, 22(7): 696-699.
11. Jin KN, Lee KW, Kim TJ, et al. Computed tomography guided percutaneous injection of a mixture of lipiodol and methylene blue in rabbit lungs: evaluation of localization ability for video-assisted thoracoscopic surgery. J Korean Med Sci, 2014, 29(1): 129-136.
12. Kleedehn M, Kim DH, Lee FT, et al. Preoperative Pulmonary Nodule Localization: A comparison of methylene blue and hookwire techniques. AJR Am J Roentgenol, 2016, 207(6):1334-1339.
13. 黃偉釗, 葉紅雨, 吳穎猛, 等. Hookwire 術前定位在胸腔鏡下肺部孤立性小結節切除術中的應用. 中國胸心血管外科臨床雜志, 2014, 21(1): 118-121.
14. Ambrogi MC, Melfi F, Zirafa C, et al. Radio-guided thoracoscopic surgery (RGTS) of small pulmonary nodules. Surg Endosc, 2012, 26(4): 914-919.
15. 姜淑云, 陳煒生, 曹燕飛, 等. 計算機導航技術在肺內小結節定位中的應用. 中國胸心血管外科臨床雜志, 2009, 16(3): 226-228.
16. Ujiie H, Kato T, Hu HP, et al. Evaluation of a new ultrasound thoracoscope for localization of lung nodules in ex vivo human lungs. Ann Thorac Surg, 2017, 103(3): 926-934.
17. Wada H, Anayama T, Hirohashi K, et al. Thoracoscopic ultrasonography for localization of subcentimetre lung nodules. Eur J Cardiothorac Surg, 2016, 49(2): 690-697.
18. Su TH, Fan YF, Jin L, et al. CT-guided localization of small pulmonary nodules using adjacent microcoil implantation prior to video-assisted thoracoscopic surgical resection. Eur Radiol, 2015, 25(9): 2627-2633.
19. Donahoe LL, Nguyen ET, Chung TB, et al. CT-guided microcoil VATS resection of lung nodules: a single-centre experience and review of the literature. J Thorac Dis, 2016, 8(8): 1986-1994.
20. Mayo JR, Clifton JC, Powell TI, et al. Lung nodules: CT-guided placement of microcoils to direct video-assisted thoracoscopic surgical resection. Radiology, 2009, 250(2): 576-585.
21. Finley RJ, Mayo JR, Grant K, et al. Preoperative computed tomography-guided microcoil localization of small peripheral pulmonary nodules: a prospective randomized controlled trial. J Thorac Cardiovasc Surg, 2015, 149(1): 26-31.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application of preoperative computed tomography-guided embolization coil localization of pulmonary nodules in thoracoscopic pulmonectomy: A randomized controlled trial

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