title: Preoperative computed tomography-guided microcoil localization of small peripheral pulmonary nodules: a prospective randomized controlled trial.
abstract: OBJECTIVE
  Growing, small, peripheral, pulmonary nodules in patients at high risk for lung cancer lead to requests for video-assisted thoracoscopic (VATS) resection for pathologic diagnosis. The purpose of this randomized controlled trial was to determine if preoperative localization using percutaneously placed computed tomography (CT)-guided platinum microcoils decreases the need for thoracotomy or VATS anatomic resection (segmentectomy/lobectomy) for diagnosis.
  
  
  METHODS
  Patients with undiagnosed nodules of 15 mm or less were randomized to either no localization or preoperative microcoil localization. Coils were placed with the distal end deep to the nodule and the superficial end coiled on the visceral pleural surface with subsequent visualization by intraoperative fluoroscopy and VATS. Nodules were removed by VATS wedge excision using endostaplers. The primary outcome was a VATS wedge excision for pathologic diagnosis of the nodule without the need for either thoracotomy or VATS anatomic resection.
  
  
  RESULTS
  Sixty patients were randomized and 56 underwent surgery between March 2010 and June 2012. Twenty-nine underwent microcoil localization and 27 did not. The baseline characteristics (age, sex, forced expiratory volume in the first second of expiration, nodule size/depth) were similar. The coil group had a higher rate of successful diagnosis with VATS wedge resection alone (27/29 vs 13/27; P < .001), decreased operative time to nodule excision (37 ± 39 vs 100 ± 67 minutes; P < .001), and reduced stapler firings (3.7 ± 2.0 vs 5.9 ± 31; P = .003) with no difference in total costs. Pathologic diagnoses included 14 benign nodules, 32 primary lung malignancies, and 10 metastases. There were no clinically significant complications related to the coil placement or wedge resection.
  
  
  CONCLUSIONS
  Preoperative CT-guided microcoil localization decreases the need for thoracotomy or VATS anatomic resection for the diagnosis of small peripheral pulmonary nodules.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: richard.finley@vch.ca.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Finley
authors.affiliation: Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: John R
authors.initials: JR
authors.lastname: Mayo
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Kyle
authors.initials: K
authors.lastname: Grant
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Joanne C
authors.initials: JC
authors.lastname: Clifton
authors.affiliation: Department of Anatomical Pathology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: John
authors.initials: J
authors.lastname: English
authors.affiliation: Department of Anatomical Pathology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Joyce
authors.initials: J
authors.lastname: Leo
authors.affiliation: Department of Respiratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Stephen
authors.initials: S
authors.lastname: Lam
mesh_terms: D000368:Aged; D001955:British Columbia; D004867:Equipment Design; D005260:Female; D057918:Fiducial Markers; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008297:Male; D011013:Pneumonectomy / Q000379:methods; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D015641:Radiography, Interventional; D017792:Surgical Stapling; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed / Q000295:instrumentation*; D016896:Treatment Outcome; D047368:Tumor Burden