A novel technique for preoperative localization of pulmonary nodules using a mixture of tissue adhesive and iohexol under computed tomography guidance: A 140 patient single‐center study

Abstract

Background The increase in the incidence of pulmonary nodules has made computed tomography (CT) screening a requirement for diagnosis and treatment. Small pulmonary nodule detection during video‐assisted thoracoscopic surgery (VATS) or thoracotomy is frequently challenging; however, accurate and efficient localization of nodules is critical for precise resection. Herein, we introduce and evaluate the feasibility and safety of a novel technique for preoperative pulmonary nodule localization. Methods From March 2018 to December 2019, 140 patients with 153 pulmonary nodules measuring <2 cm in diameter were enrolled in this study. Preoperative, CT‐guided localization was performed on each nodule with an injected mixture of tissue adhesive and iohexol. Patient and nodule characteristics, localization data, complications, surgical data, and pathological results were analyzed. Results All 153 nodules in 140 patients were successfully marked preoperatively and detected during surgery (n = 153/153). Mean nodule size was 8.7 ± 2.6 mm, and mean distance from nodule to pleura was 7.9 ± 8.2 mm. The mean procedural time was 8.7 ± 1.0 min. Nine patients (6.4%) underwent two simultaneous nodule localizations and two patients (1.4%) underwent three simultaneous nodule localizations. Pneumothorax (17/140, 12.1%), pain (6/140, 4.3%), and pungent odor (5/140, 3.6%) were the major complications. No patient required further treatment, and no allergic reactions or embolisms were observed. Conclusions Preoperative CT‐guided nodule localization using a mixture of tissue adhesive and iohexol is an efficient technique for localizing small and impalpable pulmonary lesions, including multiple pulmonary nodules. Our study demonstrates that this novel method is safe and straightforward to implement.

A localization-independent approach for invisible and impalpable ground-glass opacity nodules detection in an in vitro lung specimen: two case reports

“…Another considerable challenge is the smooth implementation of the VATS. To solve these problems, various methods have been developed for the localization of SPNs (7,8,(22)(23)(24).…”

“…Pneumothorax, pulmonary hemorrhage, hemothorax, and pleural pain are the most common complications of hook wire placement (28). Other percutaneous puncture-based techniques, such as micro coil placement (5), injection of dye materials (6), medical adhesive injection (7), contrast medium localization (29), radiotracer guided localization (30), and so on were also reported to be feasible. Complications are consistently associated with percutaneous lung punctures and lead to bad treatment experiences for patients.…”

“…^ ORCID: 0000-0003-4740-2923. methylene blue (6) or tissue adhesive injection (7), and so on. Although the success rates of the abovementioned methods have been reported as fair, most of those techniques are invasive, posing the risk of complications like pneumothorax, hemothorax, and pleural pain.…”

Intraoperative identification of pulmonary nodules during minimally invasive thoracic surgery: a narrative review

“…Some markers can be combined for clinical applications. For example, Zhang et al performed CT-guided labeling of 153 pulmonary nodules in 140 patients which were smaller than 2 cm with a mixed method of tissue adhesive and iohexol ( 58 ); Jiang et al used medical glue and MB to mark 383 nodules in 346 patients ( 59 ); Doo et al used Hookwire and 99m Tc to mark 36 nodules in 34 patients ( 60 ); Wang et al used 99m Tc and MB to label a patient successfully ( 61 ); and Brady et al localized 75 nodules with Hookwire combined with MB injection in 74 patients ( 62 ). Although these combined applications have also been associated with complications, it is presumed that they can also effectively improve the overall surgical recognition rate.…”

hsa_circ_0008234 inhibits the progression of lung adenocarcinoma by sponging miR-574-5p

“…LUAC accounts for approximately 50% of all types of LC, and its number has been increasing year by year, especially among women and young people 2 . At present, anatomical surgical resection is the most safe and effective method for patients with early-stage LUAC, including lobectomy and sublobectomy 3 . Due to the various clinical manifestations of advanced-stage LUAC, systemic and local therapies (chemotherapy, immunotherapy, radiation therapy, etc.)…”