title: Noninvasive computed tomography-guided marking technique for peripheral pulmonary nodules.
abstract: BACKGROUND
  Identification of the exact location of small peripheral pulmonary nodules during thoracoscopic wedge resection (TWR) is crucial. We describe a new method of computed tomography (CT)-guided marking without puncturing the visceral pleura (VP) for minimally palpable pulmonary nodules.
  
  
  METHODS
  Preoperative CT scans were performed 1 day before TWR with the patient in the lateral decubitus position. Under CT guidance, we marked the skin over the pulmonary nodule. During TS, an indwelling catheter was inserted perpendicular to the marked skin surface and put a mark with gentian violet (Pyoktanin blue®, Wako Pure Chemical Industries, Osaka, Japan) onto the VP. We palpated the nodules near the mark(s) and performed TWR.
  
  
  RESULTS
  Between October 2012 and April 2016, we performed CT-guided marking in 54 patients (24 males and 30 females, median age 65 years). Cases included 39 primary lung cancers, 10 metastatic lung tumors, and 5 benign tumors. The mean diameter of the nodules was 10 mm (range, 3-26 mm), and the mean distance of the nodule from the VP was 4 mm (range, 0-17 mm). The mean time of intraoperative marking was 3.5 min (range, 1-4.5 min). The mean distance from the nodule to the marking point was 7.0 mm (range, 0-30 mm). We were able to identify the location of the nodule using this procedure in 53 patients (98%). Hematoma of the chest wall after marking was observed in one patient. There were no other complications.
  
  
  CONCLUSIONS
  This marking technique is a simple, economic, and effective procedure to locate small peripheral pulmonary nodules during TWR.
authors.affiliation: Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Tokyo, Japan.
authors.forename: Mingyon
authors.initials: M
authors.lastname: Mun
authors.affiliation: Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Tokyo, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Matsuura
authors.affiliation: Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Tokyo, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Nakao
authors.affiliation: Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Tokyo, Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Ichinose
authors.affiliation: Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Tokyo, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Nakagawa
authors.affiliation: Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Tokyo, Japan.
authors.forename: Sakae
authors.initials: S
authors.lastname: Okumura
keywords: Thoracoscopic surgery; computed tomography (CT); multiple pulmonary nodules; solitary pulmonary nodule