Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Thorac Cancer. 2024 Nov;15(33):2347-2355. doi: 10.1111/1759-7714.15461. Epub 2024 Oct 11.
This study assesses the safety and efficacy of using indocyanine green (ICG) for preoperative CT-guided localization of multiple pulmonary nodules.
We included patients who underwent CT-guided preoperative ICG localization followed by video-assisted thoracoscopic surgery (VATS). Four primary outcomes were evaluated: technical success, pneumothorax, pulmonary hemorrhage, and postoperative hospital stay (PHS). Patients were classified into single nodule and multiple nodules groups, with further subgroups based on the side of localization including unilateral and bilateral subgroups. Univariate and multivariate analyses were used to evaluate risk factors for PHS and pneumothorax.
A total of 374 patients (54.8 ± 11.4 years, 99 with multiple nodules). The success rate in the multiple nodules group was 98.3%, similar to single nodules. Apart from PHS, no significant differences were observed in outcomes between patients with single and multiple nodules. Longer PHS was observed for patients with multiple nodules (3 [2-4] days vs. 3 [3-4] days, p = 0.022). Multivariable analysis indicated longer stays were associated with pulmonary hemorrhage during localization, surgical blood loss, postoperative complications, and non-segmentectomy procedures. Advanced age emerged as the sole independent risk factor for pneumothorax. The success rate in the unilateral subgroup and the bilateral subgroup was 97.8% and 99%, respectively, with higher pneumothorax rates in the unilateral subgroup (38.3% vs. 20%).
CT-guided preoperative ICG localization of multiple pulmonary nodules is safe and effective. It can be applied to both unilateral and bilateral nodules, supporting simultaneous VATS resection.
本研究评估术前 CT 引导下使用吲哚菁绿（ICG）对多个肺结节进行定位的安全性和有效性。
我们纳入了接受 CT 引导下术前 ICG 定位后行电视辅助胸腔镜手术（VATS）的患者。评估了四个主要结局：技术成功率、气胸、肺出血和术后住院时间（PHS）。患者分为单结节组和多结节组，根据定位侧进一步分为单侧和双侧亚组。采用单因素和多因素分析评估 PHS 和气胸的危险因素。
共纳入 374 例患者（54.8±11.4 岁，99 例为多结节）。多结节组的成功率为 98.3%，与单结节组相似。除 PHS 外，单结节和多结节患者在其他结局方面无显著差异。多结节患者的 PHS 时间较长（3[2-4]天 vs. 3[3-4]天，p=0.022）。多因素分析表明，定位时肺出血、手术失血量、术后并发症和非节段切除术与 PHS 时间延长相关。高龄是气胸的唯一独立危险因素。单侧亚组和双侧亚组的成功率分别为 97.8%和 99%，单侧亚组气胸发生率较高（38.3% vs. 20%）。
术前 CT 引导下吲哚菁绿定位多个肺结节安全有效。它可应用于单侧和双侧结节，支持同期 VATS 切除。
