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Using a Dedicated Lung-Marker System for Localization of Pulmonary Nodules Before Thoracoscopic Surgery

¹ Department of Radiology, Stanford University Medical Center, 300 Pasteur Dr., Rm. S-072, Stanford, CA 94305-5105.
² Department of Radiology, University of Vienna, Waehringer Guertel 18-20, A 1090 Vienna, Austria.
³ Department of Cardio-Thoracic Surgery, University of Vienna, A 1090 Vienna, Austria.
⁴ Institute of Clinical Pathology, University of Vienna, A 1090 Vienna, Austria.

OBJECTIVE. Our aim was to evaluate the effectiveness of a commercially available dedicated lung-marker system for localization of pulmonary nodules before video-assisted thoracoscopic surgery.

SUBJECTS AND METHODS. Guidewires were positioned under CT fluoroscopy guidance in 16 patients (11 men, five women; age range, 39-79 years; mean age, 60.4 years). We measured the size of the targeted nodule, its distance to the closest pleural surface, the angle between the introducer needle and the chest wall, and the time for performance of the procedure in each patient. Note was made of any complications after guidewire placement.

RESULTS. In the 16 patients, the average nodule size was 6.7 mm (range, 3-12 mm), the average distance to the pleural surface was 10.6 mm (range, 3-22 mm), and the average pleural puncture angle was 59° (range, 25-78°). The marking procedure was completed within an average of 9.5 min (range, 7-15 min). Small pneumothoraces occurred in five (31.3%) of 16 patients. In 15 (93.8%) of 16 patients, thoracoscopic resection of the targeted nodule was successful; in one patient with dyspnea (6.3%), inaccurate localization resulting in an open thoracotomy occurred because an intervening fissure was not visualized. Dislodgement of the guidewire into the pleural space occurred in one patient (6.3%).

CONCLUSION. The dedicated lung-marker system is a fast and effective method for localization of pulmonary nodules before thoracoscopic resection.

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