Pre-operative localization of solitary pulmonary nodules with computed tomography-guided hook wire: report of 181 patients

Autor: Hans-Beat Ris, Michel Gonzalez, Pierre Bize, Matthieu Hanauer, Thorsten Krueger, Jean Yannis Perentes, Sabine Schmidt
Rok vydání: 2015
Předmět:
Pulmonary and Respiratory Medicine
Adult
Male
medicine.medical_specialty
Lung Neoplasms
030204 cardiovascular system & hematology
Radiography
Interventional
Preoperative care
Ground-glass opacity
03 medical and health sciences
0302 clinical medicine
Fiducial Markers
parasitic diseases
Preoperative Care
medicine
Humans
Aged
Retrospective Studies
Aged
80 and over
Solitary pulmonary nodule
Lung
business.industry
Thoracic Surgery
Video-Assisted
Solitary Pulmonary Nodule
General Medicine
Middle Aged
medicine.disease
Female
Follow-Up Studies
Lung Neoplasms/radiography
Lung Neoplasms/surgery
Preoperative Care/instrumentation
Preoperative Care/methods
Radiography
Interventional/instrumentation
Radiography
Interventional/methods
Solitary Pulmonary Nodule/radiography
Solitary Pulmonary Nodule/surgery
Tomography
X-Ray Computed/instrumentation
Tomography
X-Ray Computed/methods
Treatment Outcome
Cardiac surgery
medicine.anatomical_structure
030228 respiratory system
Pneumothorax
Cardiothoracic surgery
Surgery
Radiology
medicine.symptom
Cardiology and Cardiovascular Medicine
business
Fiducial marker
Tomography
X-Ray Computed
Research Article
Zdroj: Journal of Cardiothoracic Surgery
Journal of Cardiothoracic Surgery, vol. 11, no. 1, pp. 5
ISSN: 1749-8090
Popis: BACKGROUND: Video-assisted thoracic surgery (VATS) is currently performed to diagnose and treat solitary pulmonary nodules (SPN). However, the intra-operative identification of deep nodules can be challenging with VATS as the lung is difficult to palpate. The aim of the study was to report the utility and the results of pre-operative computed tomography (CT)-guided hook wire localization of SPN. METHODS: All records of the patients undergoing CT-guided hook wire localization prior to VATS resection for SPN between 2002 and 2013 were reviewed. The efficacy in localizing the nodule, hook wire complications, necessity to convert VATS to thoracotomy and the histology of SPN are reported. RESULTS: One hundred eighty-one patients (90 females, mean age 63 y, range 28-82 y) underwent 187 pulmonary resections after CT-guided hook wire localization. The mean SPN diameter was 10.3 mm (range: 4-29 mm). The mean distance of the lesion from the pleural surface was 11.6 mm (range: 0-45 mm). The mean time interval from hook wire insertion to VATS resection was 224 min (range 54-622 min). Hook wire complications included pneumothorax requiring chest tube drainage in 4 patients (2.1%) and mild parenchymal haemorrhage in 11 (5.9%) patients. Migration of the hook wire occurred in 7 patients (3.7%) although it did not affect the success of VATS resection (nodule location guided by the lung puncture site). Three patients underwent additional wedge resection by VATS during the same procedure because no lesion was identified in the surgical specimen. Conversion thoracotomy was required in 13 patients (7 %) for centrally localized lesions (6 patients) and pleural adhesions (7 patients). The mean operative time was 60 min (range 18-135 min). Pathological examination revealed a malignant lesion in 107 patients (59 %). The diagnostic yield was 98.3 %. CONCLUSION: VATS resection for SPN after CT-guided hook wire localization for SPN is safe and allows for proper diagnosis with a low thoracotomy conversion rate.
Databáze: OpenAIRE
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