无法触及的肺部结节与单孔胸腔镜手术：肺多学科团队的放射引导下定位（ROLL）经验。

Non-palpable Pulmonary Nodules and Uniportal-VATS: Radio-guided Localization (ROLL) Experience of a Lung Multidisciplinary Team.

机构信息

Nuclear Medicine Unit, Humanitas Istituto Clinico Catanese, Catania, Italy.

Thoracic Surgery Unit, Humanitas Istituto Clinico Catanese, Catania, Italy.

出版信息

Anticancer Res. 2024 Aug;44(8):3507-3514. doi: 10.21873/anticanres.17171.

DOI:10.21873/anticanres.17171

PMID:39060087

Abstract

BACKGROUND/AIM: Surgical resection with a minimally invasive approach is the standard for diagnosing and treating solitary pulmonary nodules. A computed tomography (CT)-guided technetium-macroaggregated albumin (Tc-MAA) injection-based procedure has been employed for small and non-palpable lung nodule radio-guided preoperative localization (ROLL). This procedure is usually followed by video-assisted thoracoscopic surgery (VATS). This study retrospectively evaluated the feasibility, clinicopathologic outcomes, and complications of this localization radio-guided procedure followed by uniportal VATS.

PATIENTS AND METHODS

This retrospective study included 63 patients with suspicious lung nodules who underwent Tc-MAA CT-guided localization before uniportal VATS. The analysis examined the imaging and procedure characteristics, procedural risks, successful intra-operative localization, wedge resection, conversion from VATS to open thoracotomy, the reason, and histological diagnosis for each nodule. Also, it was evaluated how nodule and procedure features affected successful intra-operative localization.

RESULTS

All patients were diagnosed using a CT scan, and 90.4% had a PET scan at basal staging. A round-glass morphology was present in 9.6% of cases, whereas most had a solid appearance. The mean nodule size was 9.78 mm (maximal tumoral diameter) with a 1-23 mm range. The mean distance from the pleural surface was 15.6 mm (range=1-117 mm). The detection rate of the Tc-MAA CT-guided localization procedure was 100%. Surgical procedures were uniportal VATS and transpleural thoracoscopy in 52 (82.5%) and 11 (17.5%) patients, respectively. The intraoperative localization rate was 98.4%. Pneumothorax represented the most frequent complication (6.3%), with one case clinically significant and three only with minimal radiological evidence. Pathology confirmed radical excision in all cases.

CONCLUSION

Lung nodule localization with CT-guided Tc-MAA followed by uniportal VATS is feasible with a high success rate and low complication rate.

摘要

背景/目的：微创手术切除是诊断和治疗孤立性肺结节的标准方法。计算机断层扫描（CT）引导下锝-聚合白蛋白（Tc-MAA）注射技术已被用于小而不可触及的肺结节放射性引导术前定位（ROLL）。该程序通常随后进行电视辅助胸腔镜手术（VATS）。本研究回顾性评估了 CT 引导 Tc-MAA 定位后行单端口 VATS 的可行性、临床病理结果和并发症。

患者和方法

本回顾性研究纳入了 63 例接受 Tc-MAA CT 引导定位后行单端口 VATS 的可疑肺结节患者。分析检查了影像学和程序特征、程序风险、术中定位成功、楔形切除、从 VATS 转为开胸手术、每个结节的原因和组织学诊断。还评估了结节和程序特征如何影响术中定位成功。

结果

所有患者均通过 CT 扫描诊断，90.4%的患者在基础分期时进行了 PET 扫描。9.6%的病例呈圆形玻璃样外观，而大多数为实性外观。平均结节大小为 9.78mm（最大肿瘤直径），范围为 1-23mm。从胸膜表面的平均距离为 15.6mm（范围=1-117mm）。Tc-MAA CT 引导定位程序的检出率为 100%。手术程序分别为单端口 VATS 和经胸膜腔胸腔镜检查，分别为 52 例（82.5%）和 11 例（17.5%）。术中定位率为 98.4%。气胸是最常见的并发症（6.3%），其中 1 例为临床显著，3 例仅为轻微的影像学证据。所有病例的病理检查均证实为根治性切除。