Impalpable pulmonary nodules with ground-glass opacity: Success for making pathologic sections with preoperative marking by lipiodol.
BACKGROUND
The developments in high-resolution CT scanning have increased the chance of detecting small bronchioloalveolar carcinoma (BAC) or atypical adenomatous hyperplasia (AAH) that appears as a ground-glass opacity (GGO). However, these lesions are not only difficult to localize during surgery, but they are also hard to make pathologic sections of because they are usually impalpable. Here, we report a method of making pathologic sections for impalpable GGO lesions.


METHODS
Twenty-nine impalpable GGO lesions < 1 cm in size were marked by 0.4 to 0.5 mL of lipiodol under CT scan before surgery. The lesions were resected under C-arm fluoroscopy. The radiopaque areas marked by lipiodol within the formalin-fixed specimens were cut serially under conventional fluoroscopy for pathologic examinations.


RESULTS
The mean (+/- SD) size of the lesions was 0.5 +/- 0.2 cm (range, 0.2 to 1 cm), and the mean depth from the pleural surface was 1.6 +/- 1.4 cm (range, 0.2 to 6 cm). The mean number of sections submitted for pathologic examinations was 2.3 +/- 1.7 per lesion (range, 1 to 7 per lesion). While 11 of the 29 lesions (38%) were invisible even on the cut surface of the specimens, all were demonstrated in hematoxylin-eosin sections. The pathologic diagnosis was BAC in 17 lesions, AAH in 10 lesions, and organized pneumonia in 2 lesions. The use of lipiodol did not affect the pathologic findings.


CONCLUSIONS
The use of fluoroscopy to cut sections from resected specimens after preoperative marking with lipiodol was useful for making pathologic sections of impalpable GGOs < 1 cm in size.
Ikeda
Koei
K
Department of Thoracic Surgery, Graduate School of Medicine, Kumamoto University, Honjo 1-1-1, Kumamoto 860-8556, Japan.
Nomori
Hiroaki
H
Mori
Takeshi
T
Kobayashi
Hironori
H
Iwatani
Kazunori
K
Yoshimoto
Kentaro
K
Kawanaka
Ko-ichi
K
D003287:Contrast Media / Q000008:administration & dosage; D005471:Fluoroscopy; D006801:Humans; D007459:Iodized Oil / Q000008:administration & dosage; D008171:Lung Diseases / Q000175:diagnosis* / Q000601:surgery; D011013:Pneumonectomy / Q000379:methods; D003074:Solitary Pulmonary Nodule / Q000175:diagnosis* / Q000601:surgery; D013194:Staining and Labeling / Q000379:methods*; D025321:Surgery, Computer-Assisted
D003287:Contrast Media; D007459:Iodized Oil