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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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, 吕必宏, 何光明, 等. 孤立性肺结节早期诊治的临床策略. 中国胸心血管外科临床杂志, 2014, 21(6):793-798.
4.	宋勇, 姚艳雯. 肺部小结节的诊断和治疗近况. 中华肺部疾病杂志(电子版), 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.	张勇, 白春学. 肺癌早期诊断进展. 中华肺部疾病杂志(电子版), 2011, 4(5): 350-355.
7.	王志强, 吕德胜, 岳世昌. 电视胸腔镜手术在孤立性肺结节诊治中的价值. 中国胸心血管外科临床杂志, 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.	杨楠, 刘灿辉, 强勇, 等. 胸腔镜下孤立性肺结节术前定位进展. 中国胸心血管外科临床杂志, 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.	黄伟钊, 叶红雨, 吴颖猛, 等. Hookwire 术前定位在胸腔镜下肺部孤立性小结节切除术中的应用. 中国胸心血管外科临床杂志, 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, 陈炜生, 曹燕飞, 等. 计算机导航技术在肺内小结节定位中的应用. 中国胸心血管外科临床杂志, 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, 吕必宏, 何光明, 等. 孤立性肺结节早期诊治的临床策略. 中国胸心血管外科临床杂志, 2014, 21(6):793-798.
4. 宋勇, 姚艳雯. 肺部小结节的诊断和治疗近况. 中华肺部疾病杂志(电子版), 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. 张勇, 白春学. 肺癌早期诊断进展. 中华肺部疾病杂志(电子版), 2011, 4(5): 350-355.
7. 王志强, 吕德胜, 岳世昌. 电视胸腔镜手术在孤立性肺结节诊治中的价值. 中国胸心血管外科临床杂志, 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. 杨楠, 刘灿辉, 强勇, 等. 胸腔镜下孤立性肺结节术前定位进展. 中国胸心血管外科临床杂志, 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. 黄伟钊, 叶红雨, 吴颖猛, 等. Hookwire 术前定位在胸腔镜下肺部孤立性小结节切除术中的应用. 中国胸心血管外科临床杂志, 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, 陈炜生, 曹燕飞, 等. 计算机导航技术在肺内小结节定位中的应用. 中国胸心血管外科临床杂志, 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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