title: Preoperative Localization of Lung Nodules With Fiducial Markers: Feasibility and Technical Considerations.
abstract: BACKGROUND
  The purpose of this study was to determine whether computed tomography-guided fiducial placement is a feasible and safe localization procedure to aid resection of small pulmonary nodules.
  
  
  METHODS
  A retrospective review was performed of 20 nodules (mean size 11 mm; range, 6 to 19 mm) referred for preoperative computed tomography-guided fiducial placement in 19 patients (average age 64 ± 11 years; 13 women and 6 men).
  
  
  RESULTS
  The technical success rate for the placement of fiducials was 95%, with deployment of fiducials into the pleural space in 1 case. Biopsy specimen was obtained at time of the fiducial placement in 4 cases, with sensitivity of 75% and specificity of 100% for malignancy. Two procedures (10%) were complicated by a pneumothorax requiring chest tube placement. The median time between fiducial placement and surgery was 7 days (range, 1 to 123). One to four fiducials were placed a median distance of 0 mm (range, 0 to 7 mm) from the edge of the nodule. Fiducials were identified by on-table fluoroscopy in all cases, and all nodules were completely excised with negative surgical margins. Mean fluoroscopy time was 46 seconds, and mean radiation dose was 12.97 mGy. The final diagnosis was primary lung cancer in 85% of cases, with organizing pneumonia and sarcoidosis accounting for the three benign nodules.
  
  
  CONCLUSIONS
  Computed tomography-guided fiducial placement is a feasible and safe technique that allows biopsy at the time of the procedure and aids localization of small pulmonary nodules during video-assisted thoracic surgery.
authors.affiliation: Department of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: asharma2@mgh.harvard.edu.
authors.forename: Amita
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Department of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Shaunagh
authors.initials: S
authors.lastname: McDermott
authors.affiliation: Department of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Mathisen
authors.affiliation: Department of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Jo-Anne O
authors.initials: JO
authors.lastname: Shepard
mesh_terms: D000368:Aged; D001706:Biopsy; D005240:Feasibility Studies; D005260:Female; D057918:Fiducial Markers; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging* / Q000473:pathology; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed