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doi:10.1378/chest.06-1017
(Chest. 2007; 131:1526-1531)
© 2007 American College of Chest Physicians
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A Novel Technique for Localization of Small Pulmonary Nodules*

Weisheng Chen, MD; Long Chen, MD; Shengsheng Yang, MD; Ziqian Chen, MD; Gengnian Qian, MD; Suxun Zhang, MD and Junjie Jing, MD

* From the Departments of Thoracic and Cardiovascular Surgery (Drs. W. Chen, L. Chen, Yang, and Zhang), Radiology (Drs. Z. Chen and Qian), and Neurosurgery (Dr. Jing), Fuzhou General Hospital, Fuzhou, China.

Correspondence to: Long Chen, MD, Department of Thoracic and Cardiovascular Surgery, Fuzhou General Hospital, No. 156# Xierhuan, Fuzhou, China 350025; e-mail: chenlongdirector{at}yahoo.com

Abstract

Background: To show the safety and accuracy of a new marking technique using an image-guided technique for preoperative localization of a small pulmonary nodule.

Methods: CT data of a patient with a peripheral pulmonary nodule < 20 mm were transmitted to a surgical navigation system (StealthStation Treon Treatment Guidance System; Medtronic; Louisville, KY). To match preoperative CT image data to the physical space occupied by the patient during surgery, five to six superficial skin fiducials were used for registration. A 16-gauge needle attached by a positioning sensor was advanced into or immediately adjacent to the nodule for injection of methylene blue under guidance of the StealthStation system. Then the lesion marked by the methylene was thoracoscopically resected.

Results: Seventeen patients (12 men and 5 women; mean age, 51.3 years) underwent this procedure, and all the nodules were identified due to the precise location of the probe. They were resected with sufficient margins. There were no surgical complications. The average time of registration was 4.8 ± 0.9 min (± SD). Registration error was on average 2.7 ± 0.2 mm.

Conclusions: Image-guided navigation is useful, accurate, and safe in the localization of small peripheral lung lesions.

Key Words: image-guided navigation • preoperative localization • small pulmonary nodules • thoracoscopy






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