title: Impalpable pulmonary nodules with ground-glass opacity: Success for making pathologic sections with preoperative marking by lipiodol.
abstract: 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.
authors.affiliation: Department of Thoracic Surgery, Graduate School of Medicine, Kumamoto University, Honjo 1-1-1, Kumamoto 860-8556, Japan.
authors.forename: Koei
authors.initials: K
authors.lastname: Ikeda
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nomori
authors.forename: Takeshi
authors.initials: T
authors.lastname: Mori
authors.forename: Hironori
authors.initials: H
authors.lastname: Kobayashi
authors.forename: Kazunori
authors.initials: K
authors.lastname: Iwatani
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yoshimoto
authors.forename: Ko-ichi
authors.initials: K
authors.lastname: Kawanaka
mesh_terms: 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
chemical_list: D003287:Contrast Media; D007459:Iodized Oil