title: Impact of preoperative marking coils on surgical and pathologic management of impalpable lung nodules.
abstract: BACKGROUND
  The management of occult lung lesions, particularly subsolid opacities, is a new challenge because they are difficult to localize during surgery and the number of lesions detected by computed tomography (CT) is increasing.
  
  
  METHODS
  Between February 2008 and December 2011, preoperative CT-guided marking with coils was systematically carried out to localize presumed impalpable nodules before video-assisted thoracoscopic surgery (VATS). The procedure feasibility, reliability, and safety as well as its impact on the resection volume and on the pathologic examination strategy were examined.
  
  
  RESULTS
  This preoperative marking procedure was used for 68 nodules in 60 consecutive patients. The mean procedural time was 25 minutes/patient and complications included minimal asymptomatic pneumothorax (42 cases, 70%) and hemorrhagic suffusion (21 patients, 35%). Patients with non-retrieved coils during VATS required larger resection volumes (94.88 mm3 vs 20.65 mm3; p=0.008). The presence of a coil loop in the pleural space was not statistically associated with higher resected lung volume. Primary pulmonary adenocarcinoma was found in 42 patients (71.2%). Five nodules were associated with atypical adenomatous hyperplasia. Pathologic examination was considered to be improved by the presence of a coil next to the lesion but not within it. Coil placement modified the pathology practices for intraoperative analysis, as tissue sampling in the immediate vicinity of the coil was preferred to systematic sampling.
  
  
  CONCLUSIONS
  Impalpable lung nodules can be safely marked with coils preoperatively to improve their surgical and pathologic management.
authors: Department of Radiology, CHU Montpellier, Montpellier, France; INSERM U 1046, Université Montpellier, Montpellier, France. Electronic address: s-bommart@chu-montpellier.fr.
authors: Sébastien
authors: S
authors: Bommart
authors: Department of Respiratory Disease, CHU Montpellier, Montpellier, France; INSERM U 1046, Université Montpellier, Montpellier, France.
authors: Arnaud
authors: A
authors: Bourdin
authors: Department of Statistics, CHU Montpellier, Montpellier, France.
authors: Grégory
authors: G
authors: Marin
authors: Department of Thoracic Surgery, CHU Montpellier, Montpellier, France; INSERM U 1046, Université Montpellier, Montpellier, France.
authors: Jean Philippe
authors: JP
authors: Berthet
authors: Department of Respiratory Disease, CHU Montpellier, Montpellier, France.
authors: Jean Louis
authors: JL
authors: Pujol
authors: Department of Pathology, CHU Montpellier, Montpellier, France.
authors: Isabelle
authors: I
authors: Serre
authors: Department of Statistics, CHU Montpellier, Montpellier, France.
authors: Nicolas
authors: N
authors: Molinari
authors: Department of Thoracic Surgery, CHU Montpellier, Montpellier, France.
authors: Charles
authors: C
authors: Marty-Ané
authors: Department of Radiology, CHU Montpellier, Montpellier, France.
authors: Hélène
authors: H
authors: Kovacsik
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000000981:diagnostic imaging* / Q000601:surgery*; D010173:Palpation; D011300:Preoperative Care / Q000295:instrumentation*; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: 10