Lan-Chau Thi Kha MD, MSc, Presenter: Nothing to Disclose

Kate Hanneman MD, Abstract Co-Author: Nothing to Disclose

Taebong Chung MD, Abstract Co-Author: Nothing to Disclose

Laura Donahoe MD, Abstract Co-Author: Nothing to Disclose

Narinder S. Paul MD, Abstract Co-Author: Research funded, Toshiba Corporation

Kazuhiro Yasufuku MD, PhD, Abstract Co-Author: Nothing to Disclose

Andrew Pierre MD, Abstract Co-Author: Nothing to Disclose

Shafique Keshavjee MD, Abstract Co-Author: Nothing to Disclose

Elsie Nguyen MD, Abstract Co-Author: Nothing to Disclose

To evaluate the safety and efficacy of CT-guided percutaneous microcoil lung nodule localization prior to video-assisted thoracoscopic surgical (VATS) excision, comparing a novel approach without pleural marking to an established technique with pleural marking.

63 consecutive patients (66.6% female, mean age 61.6±11.4 years) with 64 lung nodules resected between October 2008 and January 2014 were retrospectively evaluated; 29.7% (n=19) had standard microcoil deployment with marking of the pleura and 70.3% (n=45) had microcoil deployment without marking of the pleura. Clinical, pathological and imaging characteristics, radiation dose, CT procedure and operating room time, complete resection rates, procedural and surgical complications were compared using two-sample t-test and Fisher’s exact test.

There was no significant difference in pulmonary nodule size (12.6±6.3 vs. 11.8±4.5mm, p=0.55) or nodule depth from the pleural surface (9.3±6.2 vs. 7.1±6.7 mm, p=0.22) between procedures with pleural marking compared to those without. However, mean procedure duration (53.6±18.3 vs. 72.8±25.3min, p=0.001) and total effective radiation dose (5.1±2.6 vs. 7.1±4.9mSv, p=0.039) were significantly lower in the group without pleural marking compared to those with pleural marking. There was no significant difference in total complication rate between the two groups (p=0.48), including rate of pneumothoraces (p=0.77) and pulmonary hemorrhage (p=1.00). Operating room time (p=0.91) and complete resection rates (100% with pleural marking, 98% without pleural marking, p=0.52) were similar. A single case of positive resection margins was due to severely fibrotic lungs that posed technical challenges during resection. Most frequent pathology included lung adenocarcinoma (34.4%, n=22), metastases (25.0%, n=16), and adenocarcinoma in-situ (20.3%, n=13).

CT-guided pre-operative lung nodule microcoil localization performed without visceral pleural marking results in shorter procedure time and lower radiation dose, with no significant difference in operating time, complete resection rates or complications.

A modified pre-operative lung nodule localization technique without pleural marking is safe and effective, with shorter procedure time and lower radiation dose.

Kha, L, Hanneman, K, Chung, T, Donahoe, L, Paul, N, Yasufuku, K, Pierre, A, Keshavjee, S, Nguyen, E, Pre-operative Lung Nodule Microcoil Localization without Pleural Marking: A Novel Modification of an Established Technique.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14006223.html