title: Indication for preoperative localization of small peripheral pulmonary nodules in thoracoscopic surgery.
abstract: OBJECTIVE
  Widespread clinical use of helical computed tomography has improved the detection rate for small peripheral pulmonary nodules. As a result, use of thoracoscopic surgery to confirm the diagnosis of small peripheral pulmonary nodules has become more important than ever before. However, if small peripheral pulmonary nodules are too small or located too deeply to detect thoracoscopically, it is necessary to mark the small peripheral pulmonary nodules preoperatively. The purpose of this study was to determine indications for preoperative hookwire marking in thoracoscopic resection of small peripheral pulmonary nodules.
  
  
  METHODS
  A total of 120 patients underwent thoracoscopic pulmonary resection in our institute from 1999 to 2001. Small peripheral pulmonary nodules were marked preoperatively in 61 of these patients by means of percutaneous placement of a hookwire under computed tomographic guidance. The hookwire-marked small peripheral pulmonary nodules either were smaller than 10 mm or were located more than 10 mm below the pleural surface.
  
  
  RESULTS
  Although 9 of the hookwire-marked small peripheral pulmonary nodules were easily identified during thoracoscopy, the other 52 small peripheral pulmonary nodules could not have been identified during thoracoscopy without the hookwire marking. Of the 59 small peripheral pulmonary nodules that were not hookwire marked, 7 required conversion to thoracotomy to locate the nodules. Small peripheral pulmonary nodules from both groups were examined and assigned to either an undetectable or detectable group. Discriminant function analysis indicated that a linear function (ie, depth = 0.836 x size - 2.811) could be used to differentiate between undetectable and detectable small peripheral pulmonary nodules, and preoperative hookwire marking for small peripheral pulmonary nodules should be considered for nodules in the region above those.
  
  
  CONCLUSIONS
  The results suggest that this formula might serve as an indication for preoperative marking of small peripheral pulmonary nodules in thoracoscopic resection.
authors.affiliation: Second Department of Surgery and Radiology, Akita University School of Medicine, Akita City, Japan. hsaito@doc.med.akita-u.ac.jp
authors.forename: Hajime
authors.initials: H
authors.lastname: Saito
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Minamiya
authors.forename: Ikuo
authors.initials: I
authors.lastname: Matsuzaki
authors.forename: Kasumi
authors.initials: K
authors.lastname: Tozawa
authors.forename: Kousei
authors.initials: K
authors.lastname: Taguchi
authors.forename: Taku
authors.initials: T
authors.lastname: Nakagawa
authors.forename: Manabu
authors.initials: M
authors.lastname: Hashimoto
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Hirano
authors.forename: Jun-ichi
authors.initials: J
authors.lastname: Ogawa
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012189:Retrospective Studies; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging* / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy; D036542:Tomography, Spiral Computed