Stiles Brendon M, Altes Talissa A, Jones David R, Shen K Robert, Ailawadi Gorav, Gay Spencer B, Olazagasti Juan, Rehm Patrice K, Daniel Thomas M
Department of Surgery, University of Virginia Health System, Charlottesville, Virginia 22908-0679, USA.
Ann Thorac Surg. 2006 Oct;82(4):1191-6; discussion 1196-7. doi: 10.1016/j.athoracsur.2006.04.059.
Although computed tomography lung-screening programs report a 31% to 51% incidence of subcentimeter pulmonary nodules, 85% are too small to biopsy or interrogate with positron emission spectroscopy scans. We developed a technique using transthoracic percutaneous radiotracer injection with thoracoscopic radioprobe localization and excision for small pulmonary nodules. This report describes our series of the first 46 patients evaluated with this technique.
Forty-six patients (79% smokers; 52% males; median age, 64 years) were evaluated. Patient selection was based on the surgeon's anticipated difficulty in thoracoscopically locating small nodules because of lesion size or location. Computed tomographic-guided injection of radiotracer solution was made into or adjacent to the nodule the day of surgery. Intraoperative gamma probe localization, followed by thoracoscopic excision of the lesion, was subsequently performed.
Median nodule size was 9 mm (range, 3 to 22 mm), and median depth was 5 mm (range, 0 to 50 mm). Forty-four (96%) of the lesions were successfully localized and excised. Median time from injection to surgery was 270 minutes. Failures were the result of inadvertent pleural or chest wall radiotracer placement. Forty-six percent (21 of 46) of the lesions were malignant, of which 71% (15 of 21) were primary lung cancers. Patients with lung cancer underwent lobectomy or segmentectomy. Fourteen of 15 were stage IA, whereas 1 was stage IIIB (6 mm primary with 4 mm intralobar metastasis). Complications were three pneumothoraces at the time of radiotracer injection.
Computed tomography-guided radiotracer localization of small pulmonary nodules combined with thoracoscopic excisional biopsy is feasible and safe. This technique successfully localized and excised the nodule in 96% of cases.
尽管计算机断层扫描肺部筛查项目报告称，亚厘米级肺结节的发生率为31%至51%，但85%的结节太小，无法进行活检或正电子发射光谱扫描检查。我们开发了一种技术，即经胸壁经皮放射性示踪剂注射，结合胸腔镜放射性探头定位和切除小肺结节。本报告描述了我们使用该技术评估的首批46例患者的情况。
对46例患者（79%为吸烟者；52%为男性；中位年龄64岁）进行了评估。患者的选择基于外科医生预计因病变大小或位置而在胸腔镜下定位小结节的难度。在手术当天，在计算机断层扫描引导下将放射性示踪剂溶液注射到结节内或其附近。随后进行术中γ探头定位，然后胸腔镜切除病变。
结节中位大小为9毫米（范围3至22毫米），中位深度为5毫米（范围0至50毫米）。44个（96%）病变成功定位并切除。从注射到手术的中位时间为270分钟。失败是由于放射性示踪剂意外注入胸膜或胸壁所致。46%（46例中的21例）的病变为恶性，其中71%（21例中的15例）为原发性肺癌。肺癌患者接受了肺叶切除术或肺段切除术。15例中有14例为IA期，1例为IIIB期（原发灶6毫米，叶内转移灶4毫米）。并发症为放射性示踪剂注射时发生3例气胸。
计算机断层扫描引导下小肺结节放射性示踪剂定位联合胸腔镜切除活检是可行且安全的。该技术在96%的病例中成功定位并切除了结节。
