title: Needlescopic resection of small and superficial pulmonary nodule after computed tomographic fluoroscopy-guided dual localization with radiotracer and hookwire.
abstract: OBJECTIVE
  The aim of this study was to evaluate the feasibility of a needlescopic resection for small and superficial pulmonary nodules after dual localization with radiotracer and hookwire.
  
  
  METHODS
  Computed tomography (CT) fluoroscopy-guided dual marking with hookwire and (99m)Tc-phytate was performed on 36 small and superficial pulmonary nodules of 34 patients, just before the needlescopic procedure. This method was carried out through one introducer needle, after an initial single puncture. After detection of the hookwire-marked site through needlescopy, the precise lesion was confirmed using a thoracoscopic gamma probe by calculating the highest radioactivity. The pulmonary nodule was resected and diagnosed by pathologic examination.
  
  
  RESULTS
  The mean size of the nodules was 12.5 ± 5.4 mm (range 3-20), and their mean distance from the pleural surface was 5.6 ± 5.8 mm (range 0-18.7). The time of the dual localization procedure was 10.8 ± 3.6 min (range 5-18). Pneumothorax was developed in 6 of 34 patients (17.6 %) after preoperative localization, but did not require any treatment. Seven hookwires dislodged during the operation. Nevertheless, radiotracer markings detected on a gamma probe guided a successful wedge resection without difficulty in all seven cases. All nodules were successfully resected under needlescopy, except conversion to the 5-mm-sized thoracoscopy in four patients due to pleural adhesion.
  
  
  CONCLUSIONS
  Dual marking with radiotracer and hookwire under CT fluoroscopy is a safe and not time-consuming procedure, and has made needlescopy-assisted lung resection for small and superficial nodules or ground-glass opacity lesions easier, more convenient, and less hazardous.
authors.affiliation: Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
authors.forename: Kyung Won
authors.initials: KW
authors.lastname: Doo
authors.forename: Hwan Seok
authors.initials: HS
authors.lastname: Yong
authors.forename: Hyun Koo
authors.initials: HK
authors.lastname: Kim
authors.forename: Sungeun
authors.initials: S
authors.lastname: Kim
authors.forename: Eun-Young
authors.initials: EY
authors.lastname: Kang
authors.forename: Young Ho
authors.initials: YH
authors.lastname: Choi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000473:pathology / Q000601:surgery*; D009339:Needles; D009367:Neoplasm Staging; D015609:Organotechnetium Compounds; D010833:Phytic Acid; D011030:Pneumothorax; D011300:Preoperative Care; D011379:Prognosis; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted; D013906:Thoracoscopy; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C026177:technetium phytate; D010833:Phytic Acid