Department of Radiology, China-Japan Friendship Hospital, Beijing, China.
Br J Radiol. 2020 May 1;93(1109):20190571. doi: 10.1259/bjr.20190571. Epub 2020 Feb 20.
(1) To evaluate the value of CT-guided microcoil implantation for localizing pulmonary ground-glass nodules (GGNs) before video-assisted thoracoscopic surgery (VATS). (2) To evaluate the feasibility, safety and accuracy of cephalic-caudal oblique approach for lesions difficult to access on axial images owing to overlying bony structures, large vessels or interlober fissures.
From June 2016 to March 2019, all patients with GGNs resected by VATS after marking using CT-guided microcoil implantation in China-Japan friendship hospital were enrolled and clinical and imaging data were retrospectively analyzed. According to the microcoil marked path, the GGNs were divided into cephalic-caudal oblique group (oblique group) and non-oblique group. The success rate of marking, the time required for marking and the incidence of complications between the two groups were compared.
258 GGNs from 215 consecutive patients were included in this study. The diameter of GGNs was 1.22 ± 0.50 cm, and the shortest distance from GGNs to the pleura was 1.56 ± 1.09 cm. All 258 GGNs were successfully resected by VATS under the guidance of implanted microcoils, and no case was converted to thoracotomy. During CT-guided microcoil implantation, cephalic- caudal oblique approach was taken in 56 GGNs (oblique group) to avoid bone, interlobar fissure and blood vessels. The time required for marking was significantly longer for oblique group compared with non-oblique group (16.6 ± 2.4 vs. 13.1 ± 1.9 min, <0.01). No significant differences in the success rate of marking (94.6% 91.6%), the incidence of pneumothorax (19.6% 17.8%), the bleeding rate (10.7% 8.9%), and the hemoptysis rate (1.8% 1.5%) were observed between the two groups.
CT-guided microcoil implantation can effectively guide VATS to resect GGNs. For GGNs difficult to access on axial images, CT-guided cephalic-caudal oblique approach is feasible, safe, and accurate.
CT-guided microcoil implantation can effectively guide VATS to resect GGNs. The marked path with cephalic-caudal obliquity can effectively avoid bone, interlobar fissure and blood vessels, successfully mark GGNs difficult to access on axial images, while keeping the distance from the pleura to the lesion on the marked path as short as possible at the same time.
（1）评估 CT 引导下微线圈植入术在电视辅助胸腔镜手术（VATS）前定位肺部磨玻璃结节（GGN）的价值。（2）评估头尾斜向入路对因骨结构、大血管或叶间裂而在轴位图像上难以接近的病变进行定位的可行性、安全性和准确性。
2016 年 6 月至 2019 年 3 月，在中国人民解放军总医院接受 CT 引导下微线圈植入术标记后行 VATS 切除的 GGN 患者均被纳入本研究，并对其临床和影像学资料进行回顾性分析。根据微线圈标记路径，将 GGN 分为头尾斜向组（斜向组）和非斜向组。比较两组标记的成功率、标记所需时间和并发症的发生率。
本研究纳入了 215 例连续患者的 258 个 GGN。GGN 的直径为 1.22±0.50cm，GGN 距胸膜的最短距离为 1.56±1.09cm。所有 258 个 GGN 均在植入微线圈的引导下成功行 VATS 切除，无一例中转开胸。在 CT 引导下微线圈植入过程中，为避免骨、叶间裂和血管，56 个 GGN（斜向组）采用头尾斜向入路。斜向组标记所需的时间明显长于非斜向组（16.6±2.4 比 13.1±1.9min，<0.01）。两组标记成功率（94.6%比 91.6%）、气胸发生率（19.6%比 17.8%）、出血率（10.7%比 8.9%）和咯血率（1.8%比 1.5%）差异均无统计学意义。
CT 引导下微线圈植入术可有效指导 VATS 切除 GGN。对于在轴位图像上难以接近的 GGN，CT 引导下头尾斜向入路是可行、安全和准确的。
CT 引导下微线圈植入术可有效指导 VATS 切除 GGN。头尾斜向标记路径可有效避开骨、叶间裂和血管，成功标记在轴位图像上难以接近的 GGN，同时使标记路径上的胸膜到病变的距离尽可能短。
