John Robert Mayo MD, Presenter: Nothing to Disclose

Richard Finley MD, Abstract Co-Author: Nothing to Disclose

Joanne Clifton MS, Abstract Co-Author: Nothing to Disclose

Harvey Owen Coxson PhD, Abstract Co-Author: Nothing to Disclose

Tom Powell MD, Abstract Co-Author: Nothing to Disclose

John English MD, Abstract Co-Author: Nothing to Disclose

Small growing pulmonary nodules identified on lung cancer screening examinations are best-treated using Video Assisted Thoracoscopic Surgery (VATS) resection. However, previous authors have found that VATS resection fails in 65% of small nodules that lie greater than 5mm deep to the visceral pleura surface, necessitating conversion to open thoracotomy. We describe a new microcoil technique for localizing these nodules.

Twenty-eight patients with undiagnosed pulmonary nodules less than 20mm in maximal long axis diameter were marked preoperatively using percutaneously placed CT-guided platinum microcoils. Two patients had 2 nodules excised (n=30 nodules). Using CT guidance the deep end of the coil was deployed adjacent to the growing nodule and the superficial end coiled on the pleural surface. The nodule and coil were excised with endostaplers guided by VATS and intraoperative fluoroscopy. Immediate histopathology confirmed the diagnosis.

CT-guided microcoil localization was successful in all patients with 1 small hemothorax and 2 pneumothoraces requiring a chest tube. Mean distance from visceral pleura to back of the nodule was 26.0±11.9 mm (mean±SD). VATS resection of the nodules (size=11.8 ±3.8 mm ) was successful in 29 of 30 (97%) excisions, with one patient converted to open thoracotomy. Mean microcoil localization, fluoroscopy and operative times were 38.5±12.7, 2.6±1.9 and 47.7±32.3 minutes. Eleven patients had primary non-small cell bronchogenic carcinoma (adenocarcinoma 8, bronchoalveolar cell carcinoma 1, large cell carcinoma 1, squamous cell 1) and received completion lobectomy. Nineteen patients [hamartoma 3, reactive lymph node 2, bronchoalveolar cell carcinoma 5, metastatic sarcoma 3, metastatic adenocarcinoma 4, small cell carcinoma 1; Noguchi B 1] had no further resections.

Pre-operative localization of pulmonary nodules less than 20mm in diameter using percutaneous CT-guided platinum microcoil insertion combined with intra-operative fluoroscopic visualization is a safe, effective technique which increases the success rate of VATS excision.

J.R.M.,H.O.C.: Receive equipment and financial support from Siemens Medical Solutions and GE Healthcare

Mayo, J, Finley, R, Clifton, J, Coxson, H, Powell, T, English, J, Peripheral Lung Nodules: Fluoroscopically Guided Video-assisted Thoracoscopic Resection (VATS) after CT-guided Localization Using Platinum Microcoils.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4411516.html