title: Lung nodules: CT-guided placement of microcoils to direct video-assisted thoracoscopic surgical resection.
abstract: OBJECTIVE
  To prospectively assess the safety and effectiveness of computed tomography (CT)-guided placement of fiber-coated microcoils used to guide video-assisted thoracoscopic surgical (VATS) excision of small peripheral lung nodules, with successful excision as the primary outcome and successful CT-guided microcoil placement and procedural complications as secondary outcomes.
  
  
  METHODS
  The institutional review board approved the study protocol. Informed consent was obtained from all 69 enrolled patients (30 men, 39 women; mean age, 60.7 years +/- 10.1 [standard deviation]) with 75 nodules. At CT, one end of an 80-mm long, 0.018-inch-diameter fiber-coated microcoil was placed deep to the small peripheral lung nodule, and the other end was coiled in the pleural space. VATS excision of lung tissue, nodules, and the microcoil was performed with fluoroscopic guidance.
  
  
  RESULTS
  Seventy-three (97%) 4-24-mm nodules were successfully removed at fluoroscopically guided VATS excision; two nodules could not be removed. CT-guided microcoil placement was successful in all cases; however, two (3%) of 75 coils were displaced at VATS excision. Pneumothorax requiring chest tube placement occurred in two (3%) patients, and asymptomatic hemothorax occurred in one (1%) patient. The microcoil did not impede intraoperative frozen-section histopathologic analysis, which facilitated accurate clinical management in all patients. For 19 (28%) patients, the preoperative treatment plan based on bronchoscopy, needle biopsy, and positron emission tomography findings changed after VATS excision.
  
  
  CONCLUSIONS
  Microcoil localization of small peripheral lung nodules enabled fluoroscopically guided VATS resection of 97% of the nodules, with a low rate of intervention (3%) for procedural complications.
authors.affiliation: Department of Radiology, Vancouver General Hospital Site, University of British Columbia, Vancouver, BC, Canada. john.mayo@vch.ca
authors.forename: John R
authors.initials: JR
authors.lastname: Mayo
authors.forename: Joanne C
authors.initials: JC
authors.lastname: Clifton
authors.forename: Tom I
authors.initials: TI
authors.lastname: Powell
authors.forename: John C
authors.initials: JC
authors.lastname: English
authors.forename: Ken G
authors.initials: KG
authors.lastname: Evans
authors.forename: John
authors.initials: J
authors.lastname: Yee
authors.forename: Annette M
authors.initials: AM
authors.lastname: McWilliams
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Lam
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Finley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015641:Radiography, Interventional; D020775:Thoracic Surgery, Video-Assisted; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome