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CT-Guided Agar Marking for Localization of Nonpalpable Peripheral Pulmonary Lesions^*

^* From the Department of Thoracic and Cardiovascular Surgery (Drs. Tsuchida, Yamato, Aoki, Watanabe, and Hayashi), the Department of Radiology (Dr. Koizumi), and the Department of Surgical Pathology (Dr. Emura), Niigata University School of Medicine, Niigata, Japan.

Correspondence to: Masanori Tsuchida, MD, Department of Thoracic and Cardiovascular Surgery, Niigata University School of Medicine, 1–757 Asahimachi-dori 951-8510 Japan

Background: Small pulmonary lesions with ground-glass opacity (GGO) are increasingly detected by CT; however, intraoperative localization of such lesions is difficult because these lesions are often invisible and nonpalpable.

Study objectives: To localize and resect nonpalpable and invisible small pulmonary lesions, a new marking technique that we call "agar marking" was developed.

Methods and patients: Powdered agar was dissolved in distilled water at a concentration of 5% and kept at > 50°C to maintain its liquid form. Agar was injected through an 18-gauge needle and placed near the target lesion with CT. After animal experiments, agar marking was applied to the nine patients who had lesions < 20 mm in diameter and lesions with GGO. The mean diameter of these lesions was 11 mm, with a mean depth of 19 mm from the pleural surface on CT.

Results: Agar could be detected as a hard nodule by manual palpation, and the lesion was resected during thoracotomy in all cases. There were no complications associated with the agar injection, aside from one case of slight pneumothorax.

Conclusions: Agar marking may represent a feasible alternative technique for localizing nonpalpable occult lesions located away from the pleural surface.

Key Words: agar marking • CT • ground-glass opacity • occult lesion • peripheral pulmonary lesion

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