Červeňák Vladimír, Chovanec Zdeněk, Resler Jan, Hanslík Tomáš, Berková Alena, Bílek Ondřej, Novosádová Klára, Weiss Viktor, Vaníček Jiří
Department of Medical Imaging, St. Anne's University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czechia.
1st Department of Surgery, St. Anne's University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czechia.
Case Rep Oncol. 2025 Mar 25;18(1):508-514. doi: 10.1159/000545435. eCollection 2025 Jan-Dec.
Lung cancer is one of the leading causes of death worldwide. Lung lesions, often discovered incidentally on chest CT, pose a diagnostic challenge due to their diverse etiology, including both benign and malignant nature. A key step in the assessment of these lesions is the evaluation of their morphological features in the CT image, size, and behavior over time. Nodules are divided into solid and subsolid according to their density. When surgical resection is necessary, solid lesions are palpable peroperatively, whereas subsolid lesions may be unidentifiable by palpation, and their precise localization is difficult. To spare patients from extensive surgery such as thoracotomy, it is advantageous to use one of the methods of preoperative marking of these lesions. Best practices include marking with mixtures containing patent blue and contrast agents, applied under CT guidance. This method allows accurate visualization of the localization of the lesion, which facilitates their resection by minimally invasive video-assisted surgery (VATS).
A 51-year-old female patient was found to have a subsolid lesion in the right lung during a routine follow-up CT scan of the lung for a history of malignant melanoma. The lesion was followed for 4 years and showed slow size progression and change from a pure ground glass nodule to a subsolid nodule. Due to the persistence of the nodule, change in morphology, and size progression, the patient was indicated for surgical resection. Using preoperative labeling with a mixture of blue dye and contrast agent, the nodule was successfully located and sublobary VATS resected.
The color marking allowed accurate identification of the subpleurally located lesion, which would otherwise have been unvisualized and intangible, thus minimizing the need for more extensive surgery. This case highlights the key role of color marking in increasing resection success and surgical safety, particularly in small and subsolid nodules.
肺癌是全球主要死因之一。肺部病变常在胸部CT检查时偶然发现，因其病因多样，包括良性和恶性，给诊断带来挑战。评估这些病变的关键步骤是在CT图像中评估其形态特征、大小及随时间的变化情况。结节根据密度分为实性和亚实性。当需要手术切除时，实性病变在手术中可触及，而亚实性病变可能无法通过触诊识别，其精确定位困难。为使患者避免如开胸手术等广泛手术，术前标记这些病变的方法之一具有优势。最佳做法包括在CT引导下使用含专利蓝和造影剂的混合物进行标记。这种方法能准确显示病变的定位，便于通过微创电视辅助手术（VATS）进行切除。
一名51岁女性患者，因有恶性黑色素瘤病史，在肺部常规随访CT扫描时发现右肺有一个亚实性病变。对该病变进行了4年的随访，发现其大小缓慢进展，从纯磨玻璃结节变为亚实性结节。由于结节持续存在、形态改变及大小进展，该患者被建议进行手术切除。通过术前用蓝色染料和造影剂混合物进行标记，成功定位了结节并进行了肺段下VATS切除。
颜色标记可准确识别位于胸膜下的病变，否则该病变将无法看到且无法触及，从而最大限度地减少了进行更广泛手术的必要性。该病例突出了颜色标记在提高切除成功率和手术安全性方面的关键作用，特别是在小的亚实性结节中。
