title: Radio-Guided Localization and Resection of Small or Ill-Defined Pulmonary Lesions.
abstract: BACKGROUND
  Screening programs have increased the identification of small or indistinct pulmonary lesions that are difficult to localize. We report our experience in their preoperative localization by radiotracer and resection.
  
  
  METHODS
  Patients with pulmonary nodules of subsolid morphology or smaller than 1 cm, deeper 1 cm below the visceral pleura, or both underwent computed tomography (CT)-guided injection of radiotracer technetium 99m macroaggregates in the vicinity of the lesion. During the operation, a handheld gamma probe was used to detect the hot spot where the radioactive tracer was localized, and this area was resected.
  
  
  RESULTS
  From November 2007 to May 2013, 112 patients (58 men; median age 62 years) underwent preoperative radiotracer injection with a successful marking in all patients. Adverse events included 33 (29.4%) pneumothoraces (one requiring chest tube placement), 23 (20.5%) parenchymal hemorrhage suffusions, and 1 (0.9%) allergic reaction to contrast medium. In all cases except two, the gamma probe revealed pulmonary lesions. Overall, 123 pulmonary nodules were localized and resected. The mean distance from the pleura was 12 mm (range, 0 to 39 mm). Pulmonary resection was performed by thoracoscopy in 70 (62.5%) cases, thoracotomy in 36 (32.1%), and conversion of thoracoscopy to thoracotomy in 6 (5.4%). The mean nodule size was 9 mm (range, 3 to 24 mm). Histology showed 14 (11.4%) benign lesions and 109 (88.6%) malignant lesions (85 primary lung cancers and 24 metastases).
  
  
  CONCLUSIONS
  Radiotracer localization of pulmonary lesions is a simple and feasible procedure with a high rate of success. Optimal candidates are patients with suspicious-looking nodules detected by screening or incidental CT resulting frm the high rate of nonsolid morphology and small size.
authors.affiliation: Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy. Electronic address: mimgaletta@yahoo.com.
authors.forename: Domenico
authors.initials: D
authors.lastname: Galetta
authors.affiliation: Division of Radiology, European Institute of Oncology, Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Bellomi
authors.affiliation: Division of Nuclear Medicine, European Institute of Oncology, Milan, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Grana
authors.affiliation: Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy; Department of Health Sciences, University of Milan, Milan, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Spaggiari
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000601:surgery*; D011013:Pneumonectomy; D057234:Preoperative Period; D015641:Radiography, Interventional / Q000379:methods*; D019275:Radiopharmaceuticals; D003074:Solitary Pulmonary Nodule / Q000473:pathology; D025321:Surgery, Computer-Assisted; D013668:Technetium Tc 99m Aggregated Albumin; D013906:Thoracoscopy; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin