Use of India ink during preoperative computed tomography localization of small peripheral undiagnosed pulmonary nodules for thoracoscopic resection.
BACKGROUND
Computed tomography (CT) scans of the chest permit us to identify a large number of small peripheral, undefined pulmonary lesions that require a diagnosis. Broncoscopy results are generally negative in these cases, and needle aspiration results are often inconclusive owing to poor cytology and false-negative cases. Thoracoscopy is an ideal tool but allows us only to localize lesions that retract the visceral pleura. Our aim in this study was to establish a marking procedure for excising nodules of unknown etiology by injecting India ink on the surface of the lung.


METHODS
Since January 2008, eight patients (six men, two women) who had been diagnosed as having a peripheral small pulmonary nodule of unknown etiology were selected for preoperative tattooing under CT guidance to facilitate thoracoscopic wedge resection.


RESULTS
In six cases, thoracoscopy allowed diagnosis and definitive treatment of two benign peripheral nodules and four single metastases from colon carcinoma. In two patients who had been diagnosed to have a primitive non-small-cell lung cancer on frozen section following thoracoscopy, the surgical treatment was concluded with limited lateral thoracotomy and lobectomy with ilomediastinal node dissection.


CONCLUSIONS
Our experience suggests that this CT technique, which includes using India ink to label and localize peripheral small pulmonary nodules, is a safe, valid option for marking the lung, thereby facilitating subsequent thoracoscopic resection.
Department of Surgery, S Andrea Hospital, La Spezia, Italy.
Prospero
P
Magistrelli
Luigi
L
D'Ambra
Stefano
S
Berti
Cosimo
C
Feleppa
Teseo
T
Stefanini
Emilio
E
Falco
D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D002244:Carbon; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D018570:Risk Assessment; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D013653:Tattooing / Q000379:methods; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
C028433:chinese ink; D002244:Carbon