Localization of nonpalpable pulmonary nodules using CT-guided needle puncture.
BACKGROUND
Surgical resection of small pulmonary nodule is challenging via thoracoscopic procedure. We describe our experience of computed tomography (CT)-guided needle puncture localization of indeterminate pulmonary nodules prior to video-assisted thoracoscopic surgery (VATS).


METHODS
From January 2011 to July 2014, 78 consecutive patients underwent CT-guided marking for the localization of 91 small pulmonary nodules. We retrospectively reviewed the clinical data, technical details, surgical findings and pathologic results, and complications associated with CT-guided localization.


RESULTS
Seventy-eight consecutive patients (36 men and 42 women) underwent CT-guided marking localization of 91 indeterminate pulmonary nodules (62 pure ground-glass opacity nodules, 27 part-solid nodules, and 2 solid nodules). The mean size of the nodules was 8.6 mm (3.0-23.0 mm). The mean pleural distance between the nodule and lung surface was 11.5 mm (3.0-31.3 mm). The mean procedure time of CT-guided localization was 15.2 min (8-42 min). All patients stood the procedures well without requiring conversion to open thoracotomy. Twenty-four patients (30.77%) developed pneumothorax after the procedures. Only one patient required retention of the puncture needle introducer for air drainage. The mean visual assessment pain score was 1.7 (0-3). Fifty-seven nodules (62.63%) were confirmed as malignances, including 45 primary lung cancer, and 34 nodules (37.37%) were confirmed as benign lesions.


CONCLUSIONS
CT-guided needle puncture can be an effective and safe procedure prior to VATS, enabling accurate resection and diagnosis of small pulmonary nodules.
Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Hsian-He
HH
Hsu
Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Chih-Hao
CH
Shen
Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Wen-Chuan
WC
Tsai
Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Kai-Hsiung
KH
Ko
Graduate Institute of Medical Science, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Shih-Chun
SC
Lee
Graduate Institute of Medical Science, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Hung
H
Chang
Graduate Institute of Medical Science, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. chi-wang@yahoo.com.tw.|Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, 325, Section 2, Cheng-Kung Road, Taipei, 114, Taiwan. chi-wang@yahoo.com.tw.
Tsai-Wang
TW
Huang
D000368:Aged; D005260:Female; 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 / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D020775:Thoracic Surgery, Video-Assisted; D014057:Tomography, X-Ray Computed / Q000379:methods*