Methylene Blue versus Coil-Based Computed Tomography-Guided Localization of Lung Nodules

Abstract

Background Preoperative computed tomography (CT)-guided localization has been shown to significantly improve lung nodule video-assisted thoracoscopic surgery (VATS)-based wedge resection technical success rates. However, at present, there was insufficient research regarding the optimal approaches to localization of these nodules prior to resection. We aimed to compare the relative clinical efficacy of preoperative CT-guided methylene blue and coil-based lung nodule localization. Methods In total, 91 patients with lung nodules were subjected to either CT-guided methylene blue (n = 34) or coil (n = 57) localization and VATS resection from January 2014 to December 2018. We compared baseline data, localization-associated complication rates, as well as the technical success of localization and resection between these two groups of patients. Results In total, 42 lung nodules in 34 patients underwent methylene blue localization, with associated localization and wedge resection technical success rates of 97.6 and 97.6%, respectively. A total of 71 lung nodules in 57 patients underwent coil localization, with associated localization and wedge resection technical success rates of 94.4 and 97.2%, respectively. There were no significant differences in technical success rates of localization or wedge resection between these groups (p = 0.416 and 1.000, respectively). The coil group sustained a longer duration between localization and VATS relative to the methylene blue group (13.2 vs. 2.5 hours, p = 0.003). Conclusion Both methylene blue and coil localization can be safely and effectively implemented for conducting the diagnostic wedge resection of lung nodules. The coil-based approach is compatible with a longer period of time between localization and VATS procedures.

Computed Tomography-Guided Trans-scapular Coil Localization for Pulmonary Nodules

“…8,9 VATS-guided wedge resection was conducted and successfully performed in all patients in the present study, of whom only three required additional lobectomy owing to the presence of invasive adenocarcinoma. Consistent with findings pertaining to the majority of other tested preoperative CT-guided localization strategies, [1][2][3][4][5][6] preoperative CT-guided TSCL can also achieve high wedge resection success rates when evaluating scapula-blocked PNs while preserving maximal pulmonary functionality.…”

Computed tomography-guided core needle biopsy for lung nodules: low-dose versus standard-dose protocols.

“…At present, surgical resection is widely used for the management of LNs [ 11 , 12 ]. The types of surgical resection contained sublobar resection and lobectomy [ 11 , 12 ].…”

“…At present, surgical resection is widely used for the management of LNs [ 11 , 12 ]. The types of surgical resection contained sublobar resection and lobectomy [ 11 , 12 ]. Lobectomy should be performed for invasive lung cancers, and sublobar resection can be performed for cancer in situ [ 11 , 12 ].…”

“…The types of surgical resection contained sublobar resection and lobectomy [ 11 , 12 ]. Lobectomy should be performed for invasive lung cancers, and sublobar resection can be performed for cancer in situ [ 11 , 12 ]. Therefore, the preoperative CT-guided CNB results play an important guiding role in the choice of surgery.…”

Computed tomography-guided localization for multiple pulmonary nodules: a meta-analysis.

“…Preoperative computed tomography (CT)-guided localization is commonly employed to facilitate video-assisted thoracoscopic surgery (VATS)-guided diagnostic wedge resection of pulmonary nodules (PNs), achieving high rates of successful localization (89.6-100%) and wedge resection (97-100%), with an acceptable rate of complications (8.8-12.6%) [1][2][3]. Localization methods usually involve methylene-blue, hook-wire, coils, and radio-labeling agents [1][2][3][4][5][6][7]. Relative to cases without localization, preoperative localization can significantly decrease the need for thoracotomy or VATS anatomical resection when diagnosing PNs [4].…”