Division of Thoracic Surgery, Cardiac Thoracic and Vascular Department, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy.
Surg Endosc. 2012 Apr;26(4):914-9. doi: 10.1007/s00464-011-1967-8. Epub 2011 Oct 20.
The demand for adequate tissue sampling to determine individual tumor behavior is increasing the number of lung nodule resections, even when the diagnosis is already recognized. Video-assisted thoracic surgery (VATS) is the procedure of choice for diagnosis and treatment of small pulmonary nodules. Difficulties in localizing smaller and deeper nodules have been approached with different techniques. Herein we report our 13-years' experience with radio-guided thoracoscopic resection.
Patients with pulmonary nodules smaller than 1 cm and/or deeper than 1 cm, below the visceral pleura, underwent computed tomography (CT)-guided injection of a solution, composed of 0.2 ml (99)Tc-labeled human serum albumin microspheres and 0.1 ml nonionic contrast, into the nodule. During the VATS procedure, an 11-mm-diameter collimated probe connected to a gamma ray detector was introduced to scan the lung surface. The area of major radioactivity, which matched with the area of the nodule, was resected.
From 1997 to 2009, 573 patients underwent thoracoscopic resection of small pulmonary nodules, 211 with the radio-guided technique. There were 159 men and 52 women, with an average age of 60.6 years (range = 12-83). The mean duration of the surgical procedure was 41 min (range = 20-100). The procedure was successful in 208/211 cases. Three patients (0.5%) required conversion to a minithoracotomy. The mean length of pleural drainage and hospital stay was 2.3 and 3.7 days, respectively. Histological examination showed 98 benign lesions and 113 malignant lesions (61 metastases and 52 primary lung cancers).
This study confirms that radio-guided localization of small pulmonary nodules is a feasible, safe, and quick procedure, with a high rate of success. The spread of the sentinel lymph node technique has increased the availability of technology required for RGTS.
为了确定肿瘤的个体行为，需要充分的组织采样，这导致肺结节切除的数量不断增加，即使诊断已经明确。电视辅助胸腔镜手术（VATS）是诊断和治疗小的肺结节的首选方法。对于较小和较深的结节，已经采用了不同的技术来定位。在此，我们报告我们在放射性引导下胸腔镜切除方面的 13 年经验。
对于小于 1cm 且/或位于脏层胸膜以下 1cm 以内的肺结节，在 CT 引导下将 0.2ml（99）Tc 标记的人血清白蛋白微球和 0.1ml 非离子型对比剂的溶液注入结节。在 VATS 过程中，将一个 11mm 直径的准直探头连接到伽马射线探测器，以扫描肺表面。与结节区域相匹配的放射性最强区域被切除。
1997 年至 2009 年，573 例患者接受了胸腔镜下肺小结节切除术，其中 211 例采用放射性引导技术。有 159 例男性和 52 例女性，平均年龄为 60.6 岁（范围为 12-83）。手术时间平均为 41 分钟（范围为 20-100）。208/211 例手术成功。3 例（0.5%）患者需要转为小开胸手术。胸腔引流和住院时间的平均长度分别为 2.3 天和 3.7 天。组织学检查显示 98 例良性病变和 113 例恶性病变（61 例转移瘤和 52 例原发性肺癌）。
本研究证实，放射性引导的肺小结节定位是一种可行、安全、快速的方法，成功率高。前哨淋巴结技术的普及增加了 RGTS 所需技术的可用性。
