Bertolaccini Luca, Terzi Alberto, Spada Elvira, Acchiardi Franco, Ghirardo Donatella
Thoracic Surgery Unit, S. Croce City Hospital, Via Michele Coppino 26, Cuneo, 12100, Italy.
Gen Thorac Cardiovasc Surg. 2012 May;60(5):280-4. doi: 10.1007/s11748-011-0906-x. Epub 2012 Mar 28.
This study aimed to evaluate the effectiveness of radio-guided localization for thoracoscopic resection of small nonpalpable lung nodules.
Nineteen patients with a solitary nodule were enrolled. Inclusion criteria were maximum nodule diameter <15 mm, distance from nearest pleural surface of 20-40 mm, nonsolid or partly solid nodule, and/or posterior location. Under computed tomography (CT) guidance, the nodule was identified and a needle was inserted to reach lesional or perilesional tissue. A solution of (99m)Tc macro-aggregates albumin diluted with iodized contrast medium was injected. After injection, CT and gamma scintigraphy were performed to confirm precise staining. Localization complications were minimal.
At thoracoscopy, the gamma detector probe allowed localization of nodules in all patients, with the radioactive signal being converted by the system into audio and visual numeric signals. Resection was performed, and suture margins were checked with the probe to search for residual hyperabsorption. All specimens underwent frozen section. Mean time to detect nodules with the gamma probe was 6 min (range 3-9 min). Frozen section revealed primary pulmonary tumors in eight cases, secondary lesions in four cases, and a benign nodule in the remaining seven cases.
Radio-guided localization is a simple, safe procedure for localizing nonpalpable solitary pulmonary nodules.
本研究旨在评估放射性引导定位在胸腔镜切除不可触及的小肺结节中的有效性。
纳入19例孤立性结节患者。纳入标准为最大结节直径<15 mm，距最近胸膜表面20 - 40 mm，非实性或部分实性结节，和/或位于后部。在计算机断层扫描（CT）引导下，识别结节并插入针以到达病变或病变周围组织。注入用碘化造影剂稀释的（99m）锝大聚合白蛋白溶液。注射后，进行CT和γ闪烁扫描以确认精确染色。定位并发症极少。
在胸腔镜检查时，γ探测器探头能够对所有患者的结节进行定位，放射性信号被系统转换为音频和视觉数字信号。进行了切除，并使用探头检查缝合边缘以寻找残留的高吸收区域。所有标本均进行了冰冻切片检查。使用γ探头检测结节的平均时间为6分钟（范围3 - 9分钟）。冰冻切片显示8例为原发性肺肿瘤，4例为继发性病变，其余7例为良性结节。
放射性引导定位是一种用于定位不可触及的孤立性肺结节的简单、安全的方法。
