Localization of Small Peripheral Pulmonary Lesion by Methylene Blue Injection With Radial Endobronchial Ultrasonography in Sublobar Resection

Liu, Zhengcheng; Yang, Rusong; Shao, Feng; Pan, Yanqing

doi:10.1016/j.athoracsur.2015.09.091

Cited by 6 publications

(7 citation statements)

References 6 publications

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“…As opposed to a recent study [15], a characteristic EBUS image of the peripheral nodule was obtained in only 12 cases (48%), whereas methylene blue was visible at the surface of the pleura in 95% of the cases in our series. This may be explained by the large proportion of GGOs among the patients explored (28%), by the very small size of the lesions, and by the absence of a bronchus sign in 92% of the cases.…”

Section: Discussioncontrasting

confidence: 49%

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Pleural Dye Marking Using Radial Endobronchial Ultrasound and Virtual Bronchoscopy before Sublobar Pulmonary Resection for Small Peripheral Nodules

et al. 2018

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Background: Minimally invasive surgery of pulmonary nodules allows suboptimal palpation of the lung compared to open thoracotomy. Objective: The objective of this study was to assess endoscopic pleural dye marking using radial endobronchial ultrasound (r-EBUS) and virtual bronchoscopy to localize small peripheral lung nodules immediately before minimally invasive resection. Methods: The endoscopic procedure was performed without fluoroscopy, under general anesthesia in the operating room immediately before minimally invasive surgery. Then, 1 mL of methylene blue (0.5%) was instilled into the guide sheath, wedged in the subpleural space. Wedge resection or segmentectomy were guided by visualization of the dye on the pleural surface. Contribution of dye marking to the surgical procedure was rated by the surgeon. Results: Twenty-five nodules, including 6 ground glass opacities, were resected in 22 patients by video-assisted thoracoscopic wedge resection (n = 11) or robotic-assisted thoracoscopic surgery (10 segmentectomies and 1 wedge resection). The median greatest diameter of nodules was 8 mm. No conversion to open thoracotomy was needed. The endoscopic procedure added an average 10 min to surgical resection. The dye was visible on the pleural surface in 24 cases. Histological diagnosis and free margin resection were obtained in all cases. Median skin-to-skin operating time was 90 min for robotic segmentectomy and 40 min for video-assisted wedge resection. The same operative precision was considered impossible by the surgeon without dye marking in 21 cases. Conclusions: Dye marking using r-EBUS and virtual bronchoscopy can be easily and safely performed to localize small pulmonary nodules immediately before minimally invasive resection.

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Section: Discussioncontrasting

confidence: 49%

“…Another study described a new dye-marking technique using methylene blue and radial endobronchial ultrasound (r-EBUS) [15]. Our objective was to assess a simplified dye-marking technique using a combination of virtual bronchoscopy (VB) and r-EBUS performed immediately before minimally invasive resection of SPNs or GGOs.…”

Section: Introductionmentioning

confidence: 99%

Pleural Dye Marking Using Radial Endobronchial Ultrasound and Virtual Bronchoscopy before Sublobar Pulmonary Resection for Small Peripheral Nodules

et al. 2018

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“…However, when the lesions are too small or too deep from the visceral pleura, a localization technique can also be applied . Various localizing approaches include the use of hook wires, dyes, contrast media, and radiotracers . The use of a hook wire is the most widely applied technique for localization of pulmonary lesions .…”

Section: Discussionmentioning

confidence: 99%

Modified hook‐wire placement technique for localizing multiple pulmonary nodules

Kadeer

Wang

Zhang

et al. 2018

Journal of Surgical Oncology

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Background The localization of multiple pulmonary nodules is challenging due to a high incidence of pneumothorax after each needle insertion into lung parenchyma. The aim of the current study is to verify the safety and effectiveness of a modified technique utilizing simultaneous Hookwire placement to localize multiple lesions. Methods The proposed method comprises a row of metal wires, perpendicular insertion, simultaneous release of Hookwire, and a lateral position to modify a conventional localizing technique. From January 2015 to August 2016, 23 patients were subjected to the modified technique group (Group A), while 53 patients in the conventional group (Group B). Success rates, procedural parameters, and complications were recorded and analyzed. Results Compared with Group B, Group A had higher success rate of lesion (96.7% vs 83.5%, P = 0.009), lower numbers of CT scans (2.91 vs 5.59, P < 0.001), shorter procedure duration (13.83 minutes vs 22.68 minutes, P < 0.001), and shorter distance between localizers and lesions (4.88 vs 6.29, P = 0.006). The incidence of pneumothorax in Group A was lower (21.8% vs 54.7%, P = 0.008), while lung hemorrhage was not significantly different ( P = 0.735). Lesion number and pneumothorax were risk factors for failure in multiple localizations. Conclusions The modified Hookwire placement technique was feasible and successful, which was associated with fewer computed tomography scans, shorter procedure duration, and a lower incidence of pneumothorax.

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“…Other techniques for pre-operative identification of lung nodules have been proposed including endobronchial ultrasound and navigational ultrasound. [8][9][10] However, the increased costs may make widespread application of this particular technique difficult. Additionally, these procedures often require the patient to undergo monitored anesthesia care or general anesthesia, which increases the risk of potential anesthesia complications.…”

Section: Discussionmentioning

confidence: 99%

“…1 While other techniques including navigational bronchoscopy and radial endobronchial ultrasound (EBUS) have been reported, these procedures remain expensive and not readily available in most hospitals. [8][9][10] In addition, the patient must be placed under anesthesia, which can predispose to an increased risk of complications. Given the increasing number of lung nodules, it is important to be aware of methods available to localize these lesions intra-operatively.…”

Section: Introductionmentioning

confidence: 99%

Intra-operative detection of a small lung nodule using methylene blue-is it time to revisit this technique?

Smith¹,

Buell²,

Marshall³

et al. 2020

MOJS

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Background: Small lung nodules are difficult to localize on pre-operative imaging. Methylene blue has been previously reported as a safe and cost effective method for localization. Our case report describes this method to localize a small lesion prior to surgical resection. Case report: A 42 year old woman with an incidentally discovered 4mm right upper lung nodule was injected with methylene blue using CT guidance under local anesthesia. The lung nodule was visualized intra-operatively and resected by video-assisted thorascopic surgery. Final pathology demonstrated an atypical adenomatous hyperplasia. Discussion: Previous studies demonstrated that methylene blue can safely localize lung nodules. This study was described the successful use of this technique for a small lung nodule. Conclusions: Methylene blue contrast injection using CT guidance localizes small lung nodules with a minimum size of 4mm prior to resection. Future larger studies are needed to delineate this procedure for small lung nodules.

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Localization of Small Peripheral Pulmonary Lesion by Methylene Blue Injection With Radial Endobronchial Ultrasonography in Sublobar Resection

Cited by 6 publications

References 6 publications

Pleural Dye Marking Using Radial Endobronchial Ultrasound and Virtual Bronchoscopy before Sublobar Pulmonary Resection for Small Peripheral Nodules

Pleural Dye Marking Using Radial Endobronchial Ultrasound and Virtual Bronchoscopy before Sublobar Pulmonary Resection for Small Peripheral Nodules

Modified hook‐wire placement technique for localizing multiple pulmonary nodules

Intra-operative detection of a small lung nodule using methylene blue-is it time to revisit this technique?

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