Abstract： Objective To explore the approach of clinical diagnosis and treatment strategy for patients with small pulmonary nodules （SPN）≤ 1.0 cm in size on CT. Methods We retrospectively analyzed the clinical records of 39 patients with SPN less than 1.0 cm in size who underwent lung resection at Nanjing Drum Tower Hospital from January 2005 to June 2011. There were 23 males and 16 females. Their age ranged from 31-74 （51.0±7.4） years. Nine patients had cough and sputum and other patients had no symptom. All the patients were found to have SPN less than 1.0（0.8±0.1）cm in size but not associated with hilum and mediastinal lymphadenectasis in chest CT and X-ray. The results of their sputum cytology and electronic bronchoscope were all negative. All the patients had no histologic evidence and underwent pulmonary function test prior to operation. Eleven patients had positron emission tomography/computer tomography （PET/CT）or single-photon emission computed tomography （SPECT）which was all negative. Thirteen patients underwent video-assisted minithoracotomy（VAMT） and 26 patients underwent video-assisted thoracoscopic surgery （VATS）. Results The average operation time was 121.0±48.0 min. Patients after partial lung resection were discharged 4～5 d postoperatively, and patients after lobectomy were discharged 7 d postoperatively. All the patients had no postoperative complications. Twenty one patients were identified as lung malignancy by postoperative pathology, including 9 patients with adenocarcinoma, 7 patients with bronchioloalveolar carcinoma, 1 patient with small cell lung carcinoma, and 4 patients with pulmonary metastasis. Eighteen patients had benign lesions including 4 patients with sclerosing hemangioma, 4 patients with inflammatory pseudotumor, 2 patients with pneumonia, 3 patients with granuloma, 2 patients with tuberculosis, and 3 patients with pulmonary lymph node hyperplasia. The SPN were located in left upper lobe in 11 patients, left lower lobe in 6 patients, right upper lobe in 14 patients, right middle lobe in 1 patient, and right lower lobe in 7 patients. Conclusion The diagnosis of SPN ≤1.0 cm in size on CT should consider malignance in the first step to avoid treatment delay. Patients may have a 3-month observation period to receive selective antibiotic treatment, chest CT and X-ray review after 2 to 4 weeks. CT- guided hook-wire fixation is useful to help in precise lesion localization for surgical resection. VATS and VAMT are common and effective methods for the diagnosis and treatment for SPN.
Objective To evalute the cl inical outcomes of two different surgical treatments for arachnoid cysts in sacral canal. Methods From January 2004 to March 2009, 55 cases of arachnoid cysts in the sacral canal were treated by traditonal simple sacral laminectomies with resection of the cysts (group A, 25 cases) and novel CT-guided percutaneous fibrin glue therapy of arachnoid cysts (group B, 30 cases). Of them, there were 23 males and 32 females, aging 15-66 years with an average of 42.6 years; the duration of symptoms was 6 months to 15 years with an average of 3.5 years. L5-S1 was involved in 22 cases, S1,2 in 25 cases, S2,3 in 12 cases, S2 in 8 cases, and presacral in 2 cases. The size of cysts was 1.5 cm × 1.0 cm to 6.0 cm × 2.8 cm. The MRI examination showed that all patients had cysts in the sacral canal. There were no significant difference (P gt; 0.05) in sex, ages, disease duration and cysts size between two groups. Preoperative data and postoperative lumbosacral pain and function improvement were analyzed and compared between two groups. Results All operations were performed successfully. The operative time, blood loss and hospital ization days of group B were significantly less than those of group A (P lt; 0.01). All 55 cases were followed up from 9 to 61 months (mean 23 months). In group A, postoperative cerebrospinal fluid leakage (25 cases), intracranial infection (2 cases), nerve injury (3 cases), and nerve root irritation (8 cases) occurred; in group B, mild meningitis (3 cases) and low grade fever (5 cases) occurred. Except for nerve injury, other compl ications were cured after symptomatic management. During the follow-up, 2 recurrent cases were found in group A and 1 case in group B. Of them, 2 recurrent cases were treated with CT-guided percutaneous fibrin glue therapy of arachnoid cysts, and cysts disappeared. For two groups, there were significant differences in Oswestry functional disabil ity index and visual analogue scale score between preoperation and postoperation (P lt; 0.01), and in the rate of score improvement between two groups (P lt; 0.01). According to the rating scale, the excellent and good rates of pain improvement were 64% in group A and 100% in group B; the excellent and good rates of function improvement were 24% in group A and 97% in group B. Conclusion CT-guided percutaneous fibrin glue therapy for arachnoid cysts in the sacral canal is a mini-invasive, safe, effective, and economical method, it may be better choices for the treatment of arachnoid cysts in the sacral canal.
ObjectiveTo evaluate the diagnostic value of computer tomography (CT)-guided percutaneous lung biopsy and tissue culture in pulmonary diseases. MethodsAfter the preoperative evaluation, 48 patients underwent CT-guided percutaneous lung biopsy were analyzed, and 16 patients accepted tissue culture. The clinical significance of combined diagnostic rate of histopathology and tissue culture was investigated. ResultsAll patients were punctured successfully. The pathological diagnosis confirmed 26 (54.2%) cases with malignant lesions and 16 (33.3%) cases with benign lesions. Six cases could not be pathological diagnosed. The pathological diagnostic rate was 87.5%. Sixteen patients accepted tissue culture. Among them 3 cases with benign lesions were cultured. The positive rate of tissue culture was 18.8%, and improved to 30.0% in the patients with benign lesion. The combined diagnostic rate of histopathology and tissue culture was 89.6%. In addition, the accuracy rate of pathological diagnosis in the group of lung nodules was 95.0%, higher than the others. The accuracy rate of pathological diagnosis in lung nodules of 2cm~3cm in diameter was 100.0%, and the positive rate of tissue culture in lung lump of 3cm~5cm in diameter was 25.0%. The incidence of pneumothorax and hemorrhage was 14.6%. ConclusionsCT-guided percutaneous lung biopsy is a safe and effective diagnostic method. For pulmonary infectious diseases, combination of CT-guided percutaneous lung biopsy and tissue culture can improve the early diagnostic rate.
Objective To investigate the effect of CT-guided percutaneous lung puncture biopsy and nursing of postoperative complications. Methods We retrospectively analyzed the clinical data of 522 patients who underwent CT-guided percutaneous lung biopsy between May and August 2014 in the Department of Lung Cancer Center. Effect of the puncture biopsy, postoperative complications and nursing measures were summarized. Results After surgery, 507 cases of diagnosis were confirmed, 10 were not confirmed, and 5 cases of puncture were unsuccessful. There were 203 cases of complications, including 122 cases of pneumothorax (23.4%), 56 of hemoptysis 56 (10.7%), 20 of pleural effusion (3.8%), 4 of pleural reaction (0.8%), and 1 of mediastinal emphysema (0.2%). All the above complications were cured after positive symptomatic treatment and nursing care. There were no such complications as severe hemopneumothorax, severe hemoptysis or needle tract metastasis. Conclusions CT-guided percutaneous lung puncture biopsy is a safe and reliable method, but there are some patients with complications. Observation and postoperative care are particularly important. Timely detection and positive care will achieve satisfactory results.
Objective To explore the diagnostic value and safety of CT-guided percutaneous lung biopsy (CT-PLB) for pulmonary nodules. Methods A total of 438 patients with pulmonary nodules underwent CT-PLB for further diagnosis. Results The CT-PLB was performed successfully in all 438 patients. The positive biopsy rate at the first puncture was 94.9%, and 100.0% at the second puncture. The pathology results revealed 379 (86.5%) cases of malignant lesions, 37 cases of benign lesions, and 22 cases with uncertainty. The sensitivity, specificity and accuracy of CT-PLB were 97.9% (376/384), 94.4% (51/54), and 97.4% (427/438), respectively. The first puncture induced complications included pneumothorax in 33 (7.5%) cases, blood in phlegm in 62 (14.2%) cases, pleural reaction in 7 (1.6%) cases, and bleeding at the site of puncture in 6 (1.4%) cases. There was no occurrence of neoplasm needle track implantation. The second puncture induced complications included pneumothorax in 7 (46.6%) cases and blood in phlegm in 11 (73.3%) cases. The incidences of pneumothorax and blood in phlegm were significantly higher in the patients with chronic obstructive pulmonary disease (COPD), with pulmonary lesion size＜3 cm, or with penetration depth ≥5 cm (P＜0.05). Conclusions CT-PLB is a safe method with a relatively small trauma and has good diagnostic value for pulmonary nodules. The incidence of complications increases in patients with smaller pulmonary lesions, deeper puncture, or COPD.
The iodine-125 (125I) seeds interstitial implantation has the advantages of minimal invasiveness, high local control rate, and few complications; it has attracted worldwide attention. With the application of 3D printing technology in medicine, individualized 3D templates are gradually applied to clinical practice. Individualized 3D templates combining with CT-guided 125I seeds implantation are easy to operate and can not only effectively ensure the consistency and accuracy of preoperative and postoperative dose, but also minimize complications to achieve optimal efficacy. This paper reviews the application of CT-guided implantation of 125I seeds for malignant tumors assisted by individualized 3D template, and further demonstrates the safety and effectiveness of clinical application in 125I seeds implantation to provide a reliable basis for the standardization of 125I seeds implantation.
ObjectiveTo compare the effectiveness and safety of electromagnetic navigation-guided localization and CT-guided percutaneous localization for pulmonary nodules.MethodsThe literature published from the inception to January 2021 about the comparison between electromagnetic navigation-guided localization and CT-guided percutaneous localization for pulmonary nodules in the PubMed, The Cochrane Library, Web of Science, EMbase, Chinese Wanfang database and CNKI database was searched. RevMan (version 5.4) software was used for meta-analysis. Nonrandomized controlled trials were evaluated using methodological index for nonrandomized studies (MINORS).ResultsA total of six retrospective studies (567 patients) were included in this meta-analysis. MINORS scores of all studies were all 17 points and above. There were 317 patients in the CT-guided percutaneous localization group and 250 patients in the electromagnetic navigation-guided localization group. The complication rate of the CT-guided percutaneous localization group was significantly higher than that in the electromagnetic navigation-guided localization group (OR=11.08, 95%CI 3.35 to 36.65, P<0.001). There was no significant difference in the success rate of localization (OR=0.48, 95%CI 0.16 to 1.48, P=0.20), localization time (MD=0.30, 95%CI –6.16 to 6.77, P=0.93) or nodule diameter (MD=–0.07, 95%CI –0.19 to 0.06, P=0.29) between the two groups.ConclusionElectromagnetic navigation can be used as an effective preoperative positioning method for pulmonary nodules, which has the advantage of lower complication rate compared with the traditional CT positioning method.
ObjectiveTo systematically evaluate the application effect of CT-guided Hook-wire localization and CT-guided microcoil localization in pulmonary nodules surgery. MethodsThe literatures on the comparison between CT-guided Hook-wire localization and CT-guided microcoil localization for pulmonary nodules were searched in PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang, VIP and CNKI databases from the inception to October 2021. Review Manager (version 5.4) software was used for meta-analysis. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of studies.ResultsA total of 10 retrospective cohort studies were included, with 1 117 patients including 473 patients in the CT-guided Hook-wire localization group and 644 patients in the CT-guided microcoil localization group. The quality of the studies was high with NOS scores>6 points. The result of meta-analysis showed that the difference in the localization operation time (MD=0.14, 95%CI −3.43 to 3.71, P=0.940) between the two groups was not statistically significant. However, the localization success rate of the Hook-wire group was superior to the microcoil group (OR=0.35, 95%CI 0.17 to 0.72, P=0.005). In addition, in comparison with Hook-wire localization, the microcoil localization could reduce the dislocation rate (OR=4.33, 95%CI 2.07 to 9.08, P<0.001), the incidence of pneumothorax (OR=1.62, 95%CI 1.12 to 2.33, P=0.010) and pulmonary hemorrhage (OR=1.64, 95%CI 1.07 to 2.51, P=0.020). ConclusionAlthough Hook-wire localization is slightly better than microcoil localization in the aspect of the success rate of pulmonary nodule localization, microcoil localization has an obvious advantage compared with Hook-wire localization in terms of controlling the incidence of dislocation, pneumothorax and pulmonary hemorrhage. Therefore, from a comprehensive perspective, this study believes that CT-guided microcoil localization is a preoperative localization method worthy of further promotion.
ObjectiveTo compare the imaging characteristics and surgical methods of pulmonary nodules in the external 1/3 group and internal 2/3 group. MethodsA retrospective analysis of clinical data from patients who underwent thoracoscopic preoperative CT-guided lung nodule localization at the Department of Radiology, the First Affiliated Hospital of Xiamen University from September 2020 to April 2022 was conducted. ResultsA total of 215 patients were enrolled (247 pulmonary nodules), including 70 males and 145 females, with a median age of 48.0 years. Based on the location of the nodules under CT guidance, those located in the external 1/3 area of the lung were classified into an external 1/3 group, while those located in the middle 1/3 and inner 1/3 areas were classified into an internal 2/3 group. There was no statistical difference between the two groups in terms of general clinical data, nature of pulmonary nodules, distribution of pulmonary nodules in lobes, localization time, and localization complications (P>0.05). However, there were statistical differences in the distance of pulmonary nodules from the pleura [0.6 (0.0-1.9) cm vs. 1.8 (0.0-4.5) cm, P<0.001], size of pulmonary nodules [0.7 (0.2-1.8) cm vs. 1.0 (0.2-2.0) cm, P<0.001], and surgical methods (P=0.002). In the external 1/3 group, 92.1% of nodules underwent thoracoscopic wedge resection, while fewer patients underwent other procedures; in the internal 2/3 group, 77.1% of nodules underwent thoracoscopic wedge resection, and 19.3% underwent segmentectomy. ConclusionThe diameter of pulmonary nodules, the distance of pulmonary nodules from the pleura, and surgical methods differ between the external 1/3 group and internal 2/3 group. Thoracic surgeons can develop more precise surgical plans based on the location and size of pulmonary nodules.