Application of indocyanine green combined with autologous blood and methylene blue in localizing pulmonary nodules in lung wedge resection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Zijie ¹ , FENG Zhi ^2,3 , LIN Min ^2,3 , TU Yuanrong ^2,3 ,  DU Quan ^2,3 ,  CHEN Jianfeng ^2,3

1. The First Clinical Medical College of Fujian Medical University, Fuzhou, 350122, P. R. China;
2. Department of Thoracic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, P. R. China;
3. Department of Thoracic Surgery, The First Affiliated Hospital of Fujian Medical University (Binhai Campus), National Regional Medical Center, Fuzhou, 350212, P. R. China;

Corresponding author：

DU Quan, Email: 49997929@qq.com; CHEN Jianfeng, Email: 282781840@qq.com

Keywords：

Pulmonary nodule; indocyanine green; nodule localization; lung wedge resection

DOI：

10.7507/1007-4848.202406029

Video：

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Objective To explore the feasibility and safety of using indocyanine green combined with autologous blood and methylene blue for localization of small lung nodules during thoracoscopic wedge resection. Methods Patients who underwent CT-guided percutaneous lung puncture injection of localization agents to locate lung nodules at the First Affiliated Hospital of Fujian Medical University from November 2023 to January 2024 were selected. Under thoracoscopy, lung nodules were located by white light mode, fluorescence mode, or near-infrared mode and wedge resection was performed. The feasibility of using indocyanine green combined with autologous blood and methylene blue for localization of small lung nodules was preliminarily verified by evaluating whether the localization agent concentrated around the nodules, and the safety of this method was verified by analyzing the incidence of adverse reactions during patient puncture and surgery. Results A total of 30 patients with lung nodules were included, including 10 males and 20 females, with an average age of 55.5±11.2 years. In 26 patients, the amount of localization agent used was moderate, the localization agent concentrated around the nodules, and successful precise localization of small lung nodules was achieved. Nodules were found in all resected tissues, with negative margins and a distance from the margin to the lesion that met the requirements. In 4 patients, due to excessive use of localization agent, the marker was diffuse with pleural staining. The overall localization success rate was 86.7%, and when the injection volume of localization agent was 0.2-0.5 mL, the localization success rate was 100.0%. All patients successfully completed thoracoscopic wedge resection and found nodule lesions, with negative margins and a distance from the margin to the lesion that met the requirements. Conclusion Thoracoscopic surgery using indocyanine green combined with autologous blood and methylene blue for localization of small lung nodules is safe and feasible.

1.	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2.	胡坚, 陈军, 陈昶, 等. 肺部结节(≤2 cm)楔形切除胸外科全国专家共识(2023版). 中国肺癌杂志, 2023, 26(5): 338-347.Hu J, Chen J, Chen C, et al. Lung nodules wedge resection writing committee expert consensus. National expert consensus on wedge resection of pulmonary nodules (2023 version). Chin J Lung Cancer, 2023, 26(5): 338-347.
3.	Cui F, Liu J, Du M, et al. Expert consensus on indocyanine green fluorescence imaging for thoracoscopic lung resection (the version 2022). Transl Lung Cancer Res, 2022, 11(11): 2318-2331.
4.	Aokage K, Yoshida J, Hishida T, et al. Limited resection for early-stage non-small cell lung cancer as function-preserving radical surgery: A review. Jpn J Clin Oncol, 2017, 47(1): 7-11.
5.	Lee JW, Park CH, Lee SM, et al. Planting seeds into the lung: Image-guided percutaneous localization to guide minimally invasive thoracic surgery. Korean J Radiol, 2019, 20(11): 1498-1514.
6.	Wang L, Shen S, Qu T, et al. Feasibility and safety of computed tomography-guided intrapulmonary injection of indocyanine green for localization of peripheral pulmonary ground-glass nodules. Quant Imaging Med Surg, 2023, 13(10): 7052-7064.
7.	Liao M, He Z, Xu E, et al. Value of preoperative localization techniques for solitary pulmonary nodules in singleport thoracoscopic surgery. Nan Fang Yi Ke Da Xue Xue Bao, 2020, 40(5): 718-722.
8.	Yoshida Y, Inoh S, Murakawa T, et al. Preoperative localization of small peripheral pulmonary nodules by percutaneous marking under computed tomography guidance. Interact Cardiovasc Thorac Surg, 2011, 13(1): 25-28.
9.	钱坤, 张毅, 魏博华, 等. 吲哚菁绿联合医用胶在胸腔镜下肺小结节手术定位中的应用. 中国微创外科杂志, 2020, 20(9): 818-821.Qian K, Zhang Y, Wei BH, et al. Application of indocyanine green combined with medical glue in localization of small pulmonary nodules under thoracoscope. Chin J Minim Invasive Surg, 2020, 20(9): 818-821.
10.	Sarsam M, Baste JM, Thiberville L, et al. How bronchoscopic dye marking can help minimally invasive lung surgery. J Clin Med, 2022, 11(11): 3246.
11.	Zhang J, He J, Chen J, et al. Application of indocyanine green injection guided by electromagnetic navigation bronchoscopy in localization of pulmonary nodules. Transl Lung Cancer Res, 2021, 10(12): 4414-4422.
12.	Wang K, Huang W, Chen X, et al. Efficacy of near-infrared fluorescence video-assisted thoracoscopic surgery for small pulmonary nodule resection with indocyanine green inhalation: A randomized clinical trial. Ann Surg Oncol, 2023, 30(9): 5912-5922.
13.	Sakurai N, Ishigaki K, Terai K, et al. Impact of near-infrared fluorescence imaging with indocyanine green on the surgical treatment of pulmonary masses in dogs. Front Vet Sci, 2023, 10: 1018263.
14.	Voulaz E, Giudici VM, Lanza E, et al. Percutaneous computed tomography (CT)-guided localization with indocyanine green for the thoracoscopic resection of small pulmonary nodules. J Clin Med, 2023, 12(19): 6149.
15.	Feng Z, Liao QX, Xie JB, et al. Utility of methylene blue mixed with autologous blood in preoperative localization of pulmonary nodules and masses. Open Life Sci, 2023, 18(1): 20220645.

1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2. 胡坚, 陈军, 陈昶, 等. 肺部结节(≤2 cm)楔形切除胸外科全国专家共识(2023版). 中国肺癌杂志, 2023, 26(5): 338-347.Hu J, Chen J, Chen C, et al. Lung nodules wedge resection writing committee expert consensus. National expert consensus on wedge resection of pulmonary nodules (2023 version). Chin J Lung Cancer, 2023, 26(5): 338-347.
3. Cui F, Liu J, Du M, et al. Expert consensus on indocyanine green fluorescence imaging for thoracoscopic lung resection (the version 2022). Transl Lung Cancer Res, 2022, 11(11): 2318-2331.
4. Aokage K, Yoshida J, Hishida T, et al. Limited resection for early-stage non-small cell lung cancer as function-preserving radical surgery: A review. Jpn J Clin Oncol, 2017, 47(1): 7-11.
5. Lee JW, Park CH, Lee SM, et al. Planting seeds into the lung: Image-guided percutaneous localization to guide minimally invasive thoracic surgery. Korean J Radiol, 2019, 20(11): 1498-1514.
6. Wang L, Shen S, Qu T, et al. Feasibility and safety of computed tomography-guided intrapulmonary injection of indocyanine green for localization of peripheral pulmonary ground-glass nodules. Quant Imaging Med Surg, 2023, 13(10): 7052-7064.
7. Liao M, He Z, Xu E, et al. Value of preoperative localization techniques for solitary pulmonary nodules in singleport thoracoscopic surgery. Nan Fang Yi Ke Da Xue Xue Bao, 2020, 40(5): 718-722.
8. Yoshida Y, Inoh S, Murakawa T, et al. Preoperative localization of small peripheral pulmonary nodules by percutaneous marking under computed tomography guidance. Interact Cardiovasc Thorac Surg, 2011, 13(1): 25-28.
9. 钱坤, 张毅, 魏博华, 等. 吲哚菁绿联合医用胶在胸腔镜下肺小结节手术定位中的应用. 中国微创外科杂志, 2020, 20(9): 818-821.Qian K, Zhang Y, Wei BH, et al. Application of indocyanine green combined with medical glue in localization of small pulmonary nodules under thoracoscope. Chin J Minim Invasive Surg, 2020, 20(9): 818-821.
10. Sarsam M, Baste JM, Thiberville L, et al. How bronchoscopic dye marking can help minimally invasive lung surgery. J Clin Med, 2022, 11(11): 3246.
11. Zhang J, He J, Chen J, et al. Application of indocyanine green injection guided by electromagnetic navigation bronchoscopy in localization of pulmonary nodules. Transl Lung Cancer Res, 2021, 10(12): 4414-4422.
12. Wang K, Huang W, Chen X, et al. Efficacy of near-infrared fluorescence video-assisted thoracoscopic surgery for small pulmonary nodule resection with indocyanine green inhalation: A randomized clinical trial. Ann Surg Oncol, 2023, 30(9): 5912-5922.
13. Sakurai N, Ishigaki K, Terai K, et al. Impact of near-infrared fluorescence imaging with indocyanine green on the surgical treatment of pulmonary masses in dogs. Front Vet Sci, 2023, 10: 1018263.
14. Voulaz E, Giudici VM, Lanza E, et al. Percutaneous computed tomography (CT)-guided localization with indocyanine green for the thoracoscopic resection of small pulmonary nodules. J Clin Med, 2023, 12(19): 6149.
15. Feng Z, Liao QX, Xie JB, et al. Utility of methylene blue mixed with autologous blood in preoperative localization of pulmonary nodules and masses. Open Life Sci, 2023, 18(1): 20220645.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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