Comparison of radiopaque dye materials for localization of pulmonary nodules before video-assisted thoracic surgery

Abstract

Background: Although a mixture of pigments and radiopaque materials was reported to be useful material for lung nodule localization, the optimal combination has not been well investigated. The purpose of this study is to evaluate the characteristics of various combinations of pigments and radiopaque materials for localization of pulmonary nodules prior to video-assisted thoracic surgery (VATS). Methods: We compared stability, viscosity, and visibility of 6 radiopaque dye materials of (I) mixture of indigo carmine and lipiodol; (II) mixture of indigo carmine, lipiodol, and lidocaine gel; (III) mixture of indocyanine green in water solution (w-ICG) and lipiodol; (IV) mixture of w-ICG, lipiodol, and lidocaine gel; (V) ICG in contrast medium solution (cm-ICG); and (VI) mixture of cm-ICG and lidocaine gel. Stability was evaluated by observing changes in the mixtures in the test tube with time visually and radiographically.Viscosities were measured by rotational viscometer. Materials were injected into an expanded pig-lung phantom, and area on CT and visibility on thoracoscopy camera were evaluated.Results: Separation could be seen 15 min after preparation in (I) and (III), and 1 h after preparation in (II), both visually and radiographically. In (IV), separation could be seen on the photographs but not on the X-ray images from 3 h after preparation. (V) and (VI) showed no changes within the 2-day observation period.The viscosities of the materials were (I) 0.2±0.1, (II) 2.9±0.1, (III) 0.2±0.1, (IV) 2.6±0.1, (V) 0.2±0.1, and (VI) 1.2±0.1 dPa•s. The area on CT showed very strong negative correlation with viscosity (r=−0.97). The injection point of each material was easily detected on thoracoscopy camera.Conclusions: Radiopaque dye materials appear useful for localizing pulmonary nodules before VATS; their diffusion in the lung parenchyma can be suppressed by using materials of high viscosity.

Localization Technique Using Mixture of Indigo Carmine and Lipiodol of Pulmonary Nodule via Bronchoscopic Navigation

“…Because hydrophobic and hydrophilic liquids cannot be easily commingled together, the MIL was made using a three-way stopcock and two syringes, and it was mixed 50 times to commingle the liquids together [30][31][32]. As the interval duration increased, the mixtures became separated, followed by the problem of excessive diffusion of the dye.…”

Stability and safety of transbronchial dye mixture for preoperative localization in a porcine model

“… 9 Recently, we have reported the usefulness of a dye mixture of indigo carmine and Lipiodol. 10 , 11 However, little is known about its stability and safety when injected on the visceral pleura through a bronchoscope. We performed an animal experiment to evaluate the stability and safety of indigo carmine and Lipiodol dye mixture injected on the visceral pleura of a porcine model, using bronchoscopy.…”

“…In contrast, transbronchial dye marking using flexible bronchoscopy is known as an accurate and safe procedure for locating the target pulmonary lesions 9 . Recently, we have reported the usefulness of a dye mixture of indigo carmine and Lipiodol 10,11 . However, little is known about its stability and safety when injected on the visceral pleura through a bronchoscope.…”

A review of surgery for lung metastasis from colorectal cancer

“…Dye localization was therefore introduced afterward and gradually replaced hook wire localization . [11] It provided a few advantages over hook wire, including less pneumothorax rate, ability to localize multiple location, prevention on dislodge, and improvement on discomfort complaint. Thus, CT-guided dye localization VATS operation is currently the preferred method of identifying tumor for VATS tumor excision.…”