Original article
General thoracic
Percutaneous Fiducial Localization for Thoracoscopic Wedge Resection of Small Pulmonary Nodules

Presented at the Sixtieth Annual Meeting of the Southern Thoracic Surgical Association, Scottsdale, AZ, Oct 30–Nov 2, 2013.
https://doi.org/10.1016/j.athoracsur.2014.02.028Get rights and content

Background

The advent of high-resolution computed tomography scanning and increase in use of chest imaging for high-risk patients has led to an increase in the identification of small pulmonary nodules. The ability to locate and remove these nodules through a thoracoscopic approach is difficult. The purpose of this study is to report our experience with fiducial localization and percutaneous thoracoscopic wedge resection of small pulmonary nodules.

Methods

This is a retrospective analysis of our patients who underwent computed tomography–guided fiducial localization of pulmonary nodules. Nodules were identified with intraoperative fluoroscopy and removed by thoracoscopic wedge resection.

Results

Sixty-five nodules were removed in 58 patients. Removal was successful in 98% of patients (57 of 58); 79% of the nodules (53 of 65) were cancers; 20% of these were primary lung cancers of which 9 were pure ground-glass opacities. Mean size of the nodules was 9.9 ± 4.6 mm (range, 3 to 24 mm). Mean depth from visceral pleural surface was 18.7 ± 12 mm (range, 2 to 35 mm). Mean procedure time was 58.7 ± 20.1 minutes (range, 30 to 120), and mean length of stay was 2 days (range, 1 to 6). Complications occurred in 3 patients and included fiducial embolization, fiducial migration, and parenchymal hematoma.

Conclusions

Fiducial localization facilitates identification and removal of small pulmonary nodules and alleviates the need for direct nodule palpation. As shown by our series, thoracoscopic wedge resection with fiducial localization is an accurate and efficient technique. This method provides a standardized means by which to resect small and deep pulmonary nodules or ground-glass opacities.

Section snippets

Patients and Methods

This study was performed as a retrospective review of our thoracic surgical database and was approved by our Institutional Review Board. Owing to the retrospective nature of this study and lack of patient-specific identifiers, individual patient consent was waived. From April 2011 to May 2013, 58 patients (22 female) underwent thoracoscopic resection of 65 pulmonary nodules with fiducial localization at Emory University Hospital.

Results

Sixty-five nodules were removed in 58 patients, 22 of whom were female (44%). The mean patient age was 55 years (range, 24 to 80), and the average body mass index was 29.6 ± 6.9 kg/m2 (range, 20 to 50 kg/m2). Forty-six (79%) of the patients presented with a history of cancer.

Three pneumothoraces (5%) were found immediately after the fiducial placement and treated with a pleural drain without complications. Fiducial marker and adjacent nodule removal was successful in 57 patients (98%). In 1

Comment

Increased utilization of high-resolution computed tomography and the implementation of lung cancer screening programs have led to a significant rise in the prevalence of indeterminate lung nodules 1, 2. Thoracoscopy has been progressively defined as an efficient means to provide pathologic diagnosis of these nodules, with possible concurrent definitive resection. Unfortunately, these nodules can often be subcentimeter in size, deep in the pulmonary parenchyma, and varied in texture, thus

References (24)

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