Radio-guided thoracoscopic surgery (RGTS) of small pulmonary nodules.
BACKGROUND
The demand for adequate tissue sampling to determine individual tumor behavior is increasing the number of lung nodule resections, even when the diagnosis is already recognized. Video-assisted thoracic surgery (VATS) is the procedure of choice for diagnosis and treatment of small pulmonary nodules. Difficulties in localizing smaller and deeper nodules have been approached with different techniques. Herein we report our 13-years' experience with radio-guided thoracoscopic resection.


METHODS
Patients with pulmonary nodules smaller than 1 cm and/or deeper than 1 cm, below the visceral pleura, underwent computed tomography (CT)-guided injection of a solution, composed of 0.2 ml (99)Tc-labeled human serum albumin microspheres and 0.1 ml nonionic contrast, into the nodule. During the VATS procedure, an 11-mm-diameter collimated probe connected to a gamma ray detector was introduced to scan the lung surface. The area of major radioactivity, which matched with the area of the nodule, was resected.


RESULTS
From 1997 to 2009, 573 patients underwent thoracoscopic resection of small pulmonary nodules, 211 with the radio-guided technique. There were 159 men and 52 women, with an average age of 60.6 years (range = 12-83). The mean duration of the surgical procedure was 41 min (range = 20-100). The procedure was successful in 208/211 cases. Three patients (0.5%) required conversion to a minithoracotomy. The mean length of pleural drainage and hospital stay was 2.3 and 3.7 days, respectively. Histological examination showed 98 benign lesions and 113 malignant lesions (61 metastases and 52 primary lung cancers).


CONCLUSIONS
This study confirms that radio-guided localization of small pulmonary nodules is a feasible, safe, and quick procedure, with a high rate of success. The spread of the sentinel lymph node technique has increased the availability of technology required for RGTS.
Division of Thoracic Surgery, Cardiac Thoracic and Vascular Department, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy. m.ambrogi@med.unipi.it
Marcello Carlo
MC
Ambrogi
Franca
F
Melfi
Carmelina
C
Zirafa
Marco
M
Lucchi
Annalisa
A
De Liperi
Giuliano
G
Mariani
Olivia
O
Fanucchi
Alfredo
A
Mussi
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000601:surgery*; D015641:Radiography, Interventional / Q000379:methods; D019275:Radiopharmaceuticals; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D013668:Technetium Tc 99m Aggregated Albumin; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods; D013906:Thoracoscopy / Q000379:methods*; D014057:Tomography, X-Ray Computed; D055815:Young Adult
D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin