ARRS 2022 Abstracts


E1742. Pre- and Intra-Operative CT-Guided Lung Nodule Localisation: Our Experience in a Tertiary Centre
  1. Audrey Chia; SingHealth
  2. Boon Hean Ong; SingHealth
  3. Angela Takano ; SingHealth
  4. Kun Da Zhuang; SingHealth
  5. Ing Xiang Soo; SingHealth
  6. Muhammad Syadad Bin Sulaiman; Singapore General Hospital
  7. Apoorva Gogna ; SingHealth
With increasing use of low-dose screening chest CT to decrease cancer-related mortality, there is a growing need for safe and effective histological confirmation of indeterminate and suspicious lung lesions. Minimally-invasive video-assisted thoracoscopy (VATS)-assisted limited lung resections have been shown to reduce peri-operative morbidity. The use of percutaneous transthoracic CT-guided lesion localization both pre and intra-operatively can aid in the resection of lesions that are often neither palpable nor visible on the pleural surface. We describe our experience and peri-operative outcomes at a tertiary centre.

Materials and Methods:
A retrospective review of all consecutive CT-guided localization cases between January 1, 2017 and April 30, 2021 at a single tertiary institution was performed. A total of 32 patients underwent localization for 36 nodules ranging from 3–22 mm in size via a combination of metallic device (hook wire, coil), contrast (Lipiodol) and dye (methylene blue, indocyanine green [ICG]) techniques. Three nodules were localized with a coil and ICG dye. The other 33 nodules underwent hook wire localization. Of these, eight were performed via hook wire technique only, and the rest utilized additional contrast or dye adjuncts, including methylene blue (5 nodules), ICG (17 nodules), a mixture of Lipiodol and ICG (2 nodules) and a mixture of Lipiodol and methylene blue (1 nodules). Patients then underwent VATS-assisted limited lung resection for diagnosis. Procedural and peri-operative outcomes were assessed.

Localization with subsequent resection of the lesion was successful in 100% of the cases, deemed by resection of both the marker and the nodule of concern, which was confirmed by pathologic examination. Thirteen (36%) patients had complications, of which the most common was intra or post-procedural pneumothorax (11 patients), with two patients requiring on-table aspiration. The hook wire was dislodged in one of the patients with resultant hematoma formation. In one case, the first attempt at localization was unsuccessful as the needle traversed the fissure. Immediate repeat localization was successful on the second attempt. Thirty-two (97%) wedge resections and one lobectomy were performed. Final histology showed six (17%) benign and 30 (83%) malignant nodules (Table 1). The post-operative length of stay ranged from 2 to 13 days, with a mean of 5.1 days.

The use of pre and intra-operative CT-guided localization is a safe and effective strategy to localize small lesions prior to VATS-assisted limited lung resection.