title: Not palpable? Role of radio-guided video-assisted thoracic surgery for nonpalpable solitary pulmonary nodules.
abstract: OBJECTIVE
  This study aimed to evaluate the effectiveness of radio-guided localization for thoracoscopic resection of small nonpalpable lung nodules.
  
  
  METHODS
  Nineteen patients with a solitary nodule were enrolled. Inclusion criteria were maximum nodule diameter <15 mm, distance from nearest pleural surface of 20-40 mm, nonsolid or partly solid nodule, and/or posterior location. Under computed tomography (CT) guidance, the nodule was identified and a needle was inserted to reach lesional or perilesional tissue. A solution of (99m)Tc macro-aggregates albumin diluted with iodized contrast medium was injected. After injection, CT and gamma scintigraphy were performed to confirm precise staining. Localization complications were minimal.
  
  
  RESULTS
  At thoracoscopy, the gamma detector probe allowed localization of nodules in all patients, with the radioactive signal being converted by the system into audio and visual numeric signals. Resection was performed, and suture margins were checked with the probe to search for residual hyperabsorption. All specimens underwent frozen section. Mean time to detect nodules with the gamma probe was 6 min (range 3-9 min). Frozen section revealed primary pulmonary tumors in eight cases, secondary lesions in four cases, and a benign nodule in the remaining seven cases.
  
  
  CONCLUSIONS
  Radio-guided localization is a simple, safe procedure for localizing nonpalpable solitary pulmonary nodules.
authors.affiliation: Thoracic Surgery Unit, S. Croce City Hospital, Via Michele Coppino 26, Cuneo, 12100, Italy. luca.bertolaccini@unito.it
authors.forename: Luca
authors.initials: L
authors.lastname: Bertolaccini
authors.forename: Alberto
authors.initials: A
authors.lastname: Terzi
authors.forename: Elvira
authors.initials: E
authors.lastname: Spada
authors.forename: Franco
authors.initials: F
authors.lastname: Acchiardi
authors.forename: Donatella
authors.initials: D
authors.lastname: Ghirardo
mesh_terms: D000368:Aged; D000418:Albumins / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D015552:Injections, Intralesional; D007558:Italy; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010173:Palpation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015641:Radiography, Interventional / Q000379:methods*; D011868:Radioisotopes; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D003074:Solitary Pulmonary Nodule / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D025321:Surgery, Computer-Assisted; D013667:Technetium / Q000008:administration & dosage; D020775:Thoracic Surgery, Video-Assisted; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000418:Albumins; D011868:Radioisotopes; D019275:Radiopharmaceuticals; C075321:macro aggregates of albumin; D013667:Technetium