Department of Radiology, CHU Montpellier, Montpellier, France; INSERM U 1046, Université Montpellier, Montpellier, France.
Department of Respiratory Disease, CHU Montpellier, Montpellier, France; INSERM U 1046, Université Montpellier, Montpellier, France.
Ann Thorac Surg. 2014 Feb;97(2):414-8. doi: 10.1016/j.athoracsur.2013.09.041. Epub 2013 Dec 7.
The management of occult lung lesions, particularly subsolid opacities, is a new challenge because they are difficult to localize during surgery and the number of lesions detected by computed tomography (CT) is increasing.
Between February 2008 and December 2011, preoperative CT-guided marking with coils was systematically carried out to localize presumed impalpable nodules before video-assisted thoracoscopic surgery (VATS). The procedure feasibility, reliability, and safety as well as its impact on the resection volume and on the pathologic examination strategy were examined.
This preoperative marking procedure was used for 68 nodules in 60 consecutive patients. The mean procedural time was 25 minutes/patient and complications included minimal asymptomatic pneumothorax (42 cases, 70%) and hemorrhagic suffusion (21 patients, 35%). Patients with non-retrieved coils during VATS required larger resection volumes (94.88 mm3 vs 20.65 mm3; p=0.008). The presence of a coil loop in the pleural space was not statistically associated with higher resected lung volume. Primary pulmonary adenocarcinoma was found in 42 patients (71.2%). Five nodules were associated with atypical adenomatous hyperplasia. Pathologic examination was considered to be improved by the presence of a coil next to the lesion but not within it. Coil placement modified the pathology practices for intraoperative analysis, as tissue sampling in the immediate vicinity of the coil was preferred to systematic sampling.
Impalpable lung nodules can be safely marked with coils preoperatively to improve their surgical and pathologic management.
隐匿性肺部病变，尤其是亚实性肺结节，是新的挑战，因为它们在术中难以定位，且 CT 检测到的病变数量在增加。
在 2008 年 2 月至 2011 年 12 月期间，对 60 例连续患者的 68 个假定无法触及的结节进行了术前 CT 引导下线圈标记，以实现电视辅助胸腔镜手术（VATS）前的定位。评估了该程序的可行性、可靠性和安全性，以及对切除量和病理检查策略的影响。
60 例连续患者中的 68 个结节进行了该术前标记程序。平均手术时间为 25 分钟/例，并发症包括无症状性少量气胸（42 例，70%）和出血性淤滞（21 例，35%）。VATS 中未取出的线圈的患者需要更大的切除量（94.88mm3 比 20.65mm3；p=0.008）。线圈在脏层胸膜腔中的存在与切除的肺量之间无统计学关联。42 例（71.2%）患者原发性肺腺癌。5 个结节与非典型腺瘤样增生相关。线圈紧邻病变存在被认为可改善病理检查，但不在病变内。线圈放置改变了术中分析的病理实践，更倾向于在靠近线圈的部位而不是系统采样进行组织取样。
隐匿性肺结节可以用线圈安全地进行术前标记，以改善其手术和病理管理。
