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Percutaneous Computed Tomography-Guided Radiotracer-Assisted Localization of Difficult Pulmonary Nodules in Uniportal Video-Assisted Thoracic Surgery.
J Laparoendosc Adv Surg Tech A. 2018 Dec; 28(12):1451-1457.JL

Abstract

Objective:

To report our institutional experience with radiotracer-assisted localization of lung nodules (RALN) in combination with uniportal video-assisted thoracoscopic surgery (UVATS).

Methods:

We retrospectively reviewed electronic medical records and radiology images of 27 consecutive adult patients who underwent planned UVATS lung resections combined with RALN from January 2014 to May 2017. Based on preoperative imaging, 29 nondescript nodules were marked with technetium 99 m macroaggregated albumin under computed tomography guidance before resection. Perioperative outcomes were analyzed.

Results:

All 29 nodules were successfully marked and resected with negative margins by UVATS; 12 (41.5%) were pure ground-glass opacities. Three patients had prior ipsilateral lung resections. There were no conversions to multiport VATS or thoracotomy. The majority (86.5%) of the nodules were malignant. The median nodule size was 8 mm (range: 3-20 mm) and depth, 56 mm (range: 22-150 mm). The majority (21/27; 77.8%) of patients underwent wedge resections alone, while 6 patients had anatomical resections. Median times were as follows: radiotracer injection to surgery, 219 minutes (range: 139-487 minutes); operative time, 85.5 minutes (32-236 minutes); chest tube removal, 1 day (range: 1-2 days); and length of stay, 2 days (range: 1-4 days). Four patients (14.8%) had a pigtail catheter placed for pneumothorax after radiotracer injection. One patient was readmitted 1 week after discharge for a spontaneous pneumothorax. There were no other morbidities or any 90-day mortality.

Conclusion:

RALN can be combined with UVATS to effectively resect small, deep, or low-density lung lesions that are difficult to visualize or palpate by thoracoscopy.

Authors+Show Affiliations

1 Department of Surgery, Mayo Clinic, Jacksonville, Florida.2 Department of Radiology, Mayo Clinic, Jacksonville, Florida.2 Department of Radiology, Mayo Clinic, Jacksonville, Florida.2 Department of Radiology, Mayo Clinic, Jacksonville, Florida.2 Department of Radiology, Mayo Clinic, Jacksonville, Florida.2 Department of Radiology, Mayo Clinic, Jacksonville, Florida.3 Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29979620

Citation

Dailey, Wesley A., et al. "Percutaneous Computed Tomography-Guided Radiotracer-Assisted Localization of Difficult Pulmonary Nodules in Uniportal Video-Assisted Thoracic Surgery." Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A, vol. 28, no. 12, 2018, pp. 1451-1457.
Dailey WA, Frey GT, McKinney JM, et al. Percutaneous Computed Tomography-Guided Radiotracer-Assisted Localization of Difficult Pulmonary Nodules in Uniportal Video-Assisted Thoracic Surgery. J Laparoendosc Adv Surg Tech A. 2018;28(12):1451-1457.
Dailey, W. A., Frey, G. T., McKinney, J. M., Paz-Fumagalli, R., Sella, D. M., Toskich, B. B., & Thomas, M. (2018). Percutaneous Computed Tomography-Guided Radiotracer-Assisted Localization of Difficult Pulmonary Nodules in Uniportal Video-Assisted Thoracic Surgery. Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A, 28(12), 1451-1457. https://doi.org/10.1089/lap.2018.0248
Dailey WA, et al. Percutaneous Computed Tomography-Guided Radiotracer-Assisted Localization of Difficult Pulmonary Nodules in Uniportal Video-Assisted Thoracic Surgery. J Laparoendosc Adv Surg Tech A. 2018;28(12):1451-1457. PubMed PMID: 29979620.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Percutaneous Computed Tomography-Guided Radiotracer-Assisted Localization of Difficult Pulmonary Nodules in Uniportal Video-Assisted Thoracic Surgery. AU - Dailey,Wesley A, AU - Frey,Gregory T, AU - McKinney,J Mark, AU - Paz-Fumagalli,Ricardo, AU - Sella,David M, AU - Toskich,Beau B, AU - Thomas,Mathew, Y1 - 2018/07/06/ PY - 2018/7/7/pubmed PY - 2019/9/10/medline PY - 2018/7/7/entrez KW - ground-glass opacity KW - lung cancer KW - lung nodule KW - minimally invasive thoracic surgery KW - radiotracer localization KW - uniportal VATS SP - 1451 EP - 1457 JF - Journal of laparoendoscopic & advanced surgical techniques. Part A JO - J Laparoendosc Adv Surg Tech A VL - 28 IS - 12 N2 - Objective: To report our institutional experience with radiotracer-assisted localization of lung nodules (RALN) in combination with uniportal video-assisted thoracoscopic surgery (UVATS). Methods: We retrospectively reviewed electronic medical records and radiology images of 27 consecutive adult patients who underwent planned UVATS lung resections combined with RALN from January 2014 to May 2017. Based on preoperative imaging, 29 nondescript nodules were marked with technetium 99 m macroaggregated albumin under computed tomography guidance before resection. Perioperative outcomes were analyzed. Results: All 29 nodules were successfully marked and resected with negative margins by UVATS; 12 (41.5%) were pure ground-glass opacities. Three patients had prior ipsilateral lung resections. There were no conversions to multiport VATS or thoracotomy. The majority (86.5%) of the nodules were malignant. The median nodule size was 8 mm (range: 3-20 mm) and depth, 56 mm (range: 22-150 mm). The majority (21/27; 77.8%) of patients underwent wedge resections alone, while 6 patients had anatomical resections. Median times were as follows: radiotracer injection to surgery, 219 minutes (range: 139-487 minutes); operative time, 85.5 minutes (32-236 minutes); chest tube removal, 1 day (range: 1-2 days); and length of stay, 2 days (range: 1-4 days). Four patients (14.8%) had a pigtail catheter placed for pneumothorax after radiotracer injection. One patient was readmitted 1 week after discharge for a spontaneous pneumothorax. There were no other morbidities or any 90-day mortality. Conclusion: RALN can be combined with UVATS to effectively resect small, deep, or low-density lung lesions that are difficult to visualize or palpate by thoracoscopy. SN - 1557-9034 UR - https://www.unboundmedicine.com/medline/citation/29979620/Percutaneous_Computed_Tomography_Guided_Radiotracer_Assisted_Localization_of_Difficult_Pulmonary_Nodules_in_Uniportal_Video_Assisted_Thoracic_Surgery_ L2 - https://www.liebertpub.com/doi/full/10.1089/lap.2018.0248?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -