Kyungwon Doo, Presenter: Nothing to Disclose

Hwan Seok Yong MD, Abstract Co-Author: Nothing to Disclose

Yoon Kyung Kim MD, Abstract Co-Author: Nothing to Disclose

Eun-Young Kang MD, Abstract Co-Author: Nothing to Disclose

Hyun Koo Kim MD,PhD, Abstract Co-Author: Nothing to Disclose

Ok Hee Woo MD, Abstract Co-Author: Nothing to Disclose

The aim of our study was to evaluate the usefulness of combined mammographic hook wire anchoring and lipiodol injection for localization of small pulmonary nodules which was performed under CT-fluoroscopy guidance before needlescopic lung biopsy.

CT fluoroscopy guided pulmonary nodule localization was performed in 33 nodules in 26 patients.   Among them, only hook wire anchoring was done in 8 nodules of 6 patients, and combined hook wire anchoring and lipiodol injection in 25 nodules in 20 patients. The introducer needle was advanced into the nodule under intermittent CT fluoroscopy guidance. Then 0.2ml of lipiodol contained in 1ml syringe was injected at the center of the nodule, and mammographic hook wire was deployed at the same location. These combined methods were performed through one introducer needle after first single-puncture. Immediate CT scans were performed to confirm that the lipiodol and the hook wire tip were correctly positioned, and to determine whether procedure-related complications were occurred.

Nodules were on average 6.5±3.2 mm in diameter and located at an average distance of 12.2±13.6 mm from the pleural surface. The marking procedure was completed within an average time of 13.6±5.4 minutes. All the lesions were successfully localized without major complication. Only minor complications such as minimal pneumothoraces (6 of 33), and minimal intrapulmonary hemorrhage (1 of 33) were developed.During surgeries, the site of pulmonary nodules was found by needlescopic detection of a hook wire and their resection margin was decided by lipiodol showed on the C-arm fluoroscopic monitor. Needlescopic wedge resections were successful in 32 of 33 nodules (97.0%). Dislodgement of hook wire occurred in one nodule (1 of 33, 3.0%) in the group using only hook wire without lipiodol injection.

In conclusion, combined method of mammographic hook wire anchoring and lipiodol injection under CT fluoroscopy is useful and cost effective for localization of small pulmonary nodules before needlescopic lung biopsy.

When the nodules are too small and located deep portion under pleural surface to find the lesion by needlescopy, preoperative localization using combined method should be considered.

Doo, K, Yong, H, Kim, Y, Kang, E, Kim, H, Woo, O, CT Fluoroscopy Guided Small Pulmonary Nodule Localization Using Mammographic Hook-wire Anchoring and Lipiodol Injection before Needlescopic Lung Biopsy.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8014864.html