Radioisotope marking under CT guidance and localization using a handheld gamma probe for small or indistinct pulmonary lesions.
OBJECTIVE
A new marking technique was developed to localize small or indistinct pulmonary lesions, involving preoperative radioisotope injection and intraoperative detection with a handheld gamma probe.


METHODS
National hospital for respiratory disease.


METHODS
and patients: A technetium suspension (either (99m)Tc tin colloid [2 to 4 mCi, 0.5 to 2.5 mL] or (99m)Tc phytate [2 mCi, 2.0 mL]) was injected preoperatively in the vicinity of the lesion under CT guidance in 25 patients with small or indistinct pulmonary lesions. A handheld gamma probe (Navigator GPS; Tyco Healthcare Japan; Tokyo, Japan) was used to detect the hot spot where radioactivity was localized during surgery. The lesion marked by the radioisotope then was thoracoscopically resected using endostaplers.


RESULTS
The preoperative marking procedure took approximately 30 min. A small pneumothorax and mild intrapulmonary bleeding were observed in two patients and one patient, respectively, but no additional treatment was needed for these complications. The lesion was resected soon after the marking procedure in 21 patients, and on the next day in 4 patients. All lesions were easily identified during surgery as radioactive hot spots detected by the handheld gamma probe. Thoracoscopic wedge resection was successfully performed in all patients without complications.


CONCLUSIONS
This new marking technique for small or indistinct pulmonary lesions (radioisotope injection under CT guidance and intraoperative detection with a handheld gamma probe) seems to be safe, reliable, and convenient.
Sugi
Kazuro
K
Department of Clinical Research, Sanyo National Hospital, Ube, Japan. ksugi@sanyou.hosp.go.jp
Kaneda
Yoshikazu
Y
Hirasawa
Katutoshi
K
Kunitani
Naoki
N
D003102:Colloids; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D010833:Phytic Acid; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging* / Q000601:surgery; D017556:Technetium Compounds; D013906:Thoracoscopy; D017971:Tin Compounds; D014057:Tomography, X-Ray Computed
D003102:Colloids; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D017556:Technetium Compounds; D017971:Tin Compounds; C033493:technetium Tc 99m tin colloid; C026177:technetium phytate; D010833:Phytic Acid