Thoracoscopic localization techniques for patients with solitary pulmonary nodule and history of malignancy.
BACKGROUND
Our aim was to evaluate the best intrathoracoscopic localization technique in patients with single pulmonary nodule and a history of malignancy.


METHODS
We divided 50 patients in two groups, well matched for diameter and depth of the pulmonary lesion. In 25 patients we performed intrathoracoscopic ultrasound to locate the pulmonary nodule (group A), whereas in the other 25 patients the radio-guided technique was adopted (group B). In both group A and group B, the localization techniques were compared with finger palpation. In group A, 12 nodules were in the left lung and 13 in the right one; in group B, 11 lesions were in the left and 14 in the right lung. In both groups, the distance of the nodule from the pleural surface was 2.6 +/- 0.5 cm (2 to 2.5 cm in 14 patients, and >2.5 cm for the remaining 11). The diameter of the nodule was 1.26 +/- 0.22 (< or =1 cm in 10 patients, and 1 to 1.5 cm in 15) in both groups. All patients underwent thoracoscopic wedge resection, and 10 patients with a primary pulmonary lesion underwent posterior-lateral thoracotomy for lobectomy and mediastinal lymphadenectomy.


RESULTS
In group A, ultrasound localized the nodule in 24 of 25 patients (96%) whereas finger palpation localized it in 19 of 25 (76%; not significant). In group B, both the radio-guided and finger palpation techniques localized the nodule in 20 of 25 patients (80%; not significant). No complications were recorded with the ultrasound technique; however, 10 cases of pneumothorax were detected after the radio-guided technique (p < 0.01).


CONCLUSIONS
Both the ultrasound and radio-guided techniques are accurate to detect solitary pulmonary nodules, but the radio-guided method yields complications as compared with the ultrasound.
Sortini
Davide
D
Section of General Surgery, Department of Surgical, Anaesthesiological and Radiological Sciences, University of Ferrara, Ferrara, Italy. sors@libero.it
Feo
Carlo V
CV
Carcoforo
Paolo
P
Carrella
Giovanni
G
Pozza
Enzo
E
Liboni
Alberto
A
Sortini
Andrea
A
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery; D003110:Colonic Neoplasms; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006222:Hamartoma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery; D008197:Lymph Node Excision; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery; D008875:Middle Aged; D010173:Palpation; D016726:Plasma Cell Granuloma, Pulmonary / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D011013:Pneumonectomy / Q000379:methods; D011014:Pneumonia / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D015641:Radiography, Interventional; D012680:Sensitivity and Specificity; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D013906:Thoracoscopy; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional / Q000009:adverse effects