A proposed diagnostic approach to the patient with the subcentimeter pulmonary nodule: techniques that facilitate video-assisted thoracic surgery excision.
This article describes a diagnostic approach to the management of subcentimeter pulmonary nodules and delineates the contribution the chest surgeon brings to clinical decision making. This includes clinical experience and knowledge of nodule accessibility to thoracoscopic excisional biopsy based on the anticipated localization technique to be used. Characteristics of the ideal localization technique are discussed. Different localization techniques are then described, and their respective advantages and disadvantages are discussed. These techniques include intraoperative finger and instrument localization, preoperative radiologically placed hooks and coils, intraoperative ultrasonography, and preoperative placement of radiotracer markers.
Daniel
Thomas M
TM
Division of Thoracic Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia 22908-0679, USA. tmd5m@virginia.edu
D018288:Carcinoma, Small Cell / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D007091:Image Processing, Computer-Assisted / Q000379:methods / Q000639:trends; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D003074:Solitary Pulmonary Nodule / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000639:trends; D018084:Ultrasonography, Interventional / Q000379:methods / Q000639:trends