Altomare Carlo, Casati Rebecca, Pacella Giuseppina, Olivieri Laura, Tirabasso Angelo, Altomare Annamaria, Frasca Luca, Longo Filippo, Crucitti Pierfilippo, Faiella Eliodoro, Beomonte Zobel Bruno, Grasso Rosario Francesco
Unit of Diagnostic Imaging and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy.
Thorac Cancer. 2025 Sep;16(17):e70152. doi: 10.1111/1759-7714.70152.
This study evaluates the effectiveness and safety of C-arm cone beam CT (CBCT)-guided microcoil localization combined with uniportal video-assisted thoracoscopic surgery (VATS) for the management of small, difficult-to-localize ground-glass opacities (GGOs) and sub-solid nodules in the lungs.
We retrospectively analyzed data from 13 patients with single, small, peripheral, non-subpleural GGOs or SSN. All patients underwent successful microcoil localization using CB-CT guidance followed by uniportal VATS resection. A microcoil was positioned partly in the lung parenchyma and partly in the extra-pleural space to assist in intraoperative localization. We evaluated the rate of correct microcoil placement and the technical success of the resection.
Microcoil placement was successfully performed in all patients, with an average procedure time of 28.8 ± 10.8 min. The mean nodule size was 9.9 ± 5.4 mm, and 76.9% of the nodules were classified as ground-glass opacities. No intraparenchymal bleeding was observed, and four patients (30.8%) experienced pneumothorax, all of which were self-limited and required no intervention or coil repositioning. The uniVATS resection success rate was 100%.
CBCT-guided microcoil localization, with partial placement of the coil in the extra-pleural space, proved to be a highly effective technique for the localization and resection of small pulmonary nodules. The procedure demonstrated high accuracy, minimal complications, reduction of procedural time, and short hospital stays. Intraoperative fluoroscopy was never necessary, with a high reduction in radiation exposure for the patient and the operator. Further studies with larger populations and longer follow-ups are needed to validate these findings.
本研究评估C形臂锥形束CT（CBCT）引导下微线圈定位联合单孔电视辅助胸腔镜手术（VATS）治疗肺部小的、难以定位的磨玻璃影（GGO）和亚实性结节的有效性和安全性。
我们回顾性分析了13例单发、小的、外周、非胸膜下GGO或SSN患者的数据。所有患者在CB-CT引导下成功进行了微线圈定位，随后接受单孔VATS切除。将微线圈部分置于肺实质内，部分置于胸膜外间隙以辅助术中定位。我们评估了微线圈正确放置的比例和切除的技术成功率。
所有患者均成功进行了微线圈放置，平均手术时间为28.8±10.8分钟。平均结节大小为9.9±5.4毫米，76.9%的结节被分类为磨玻璃影。未观察到实质内出血，4例患者（30.8%）发生气胸，均为自限性，无需干预或重新定位线圈。单孔VATS切除成功率为100%。
CBCT引导下微线圈定位，将线圈部分置于胸膜外间隙，被证明是一种用于定位和切除小的肺结节的高效技术。该手术显示出高准确性、最小并发症、手术时间缩短和住院时间缩短。术中从未需要透视，患者和操作者的辐射暴露大幅减少。需要进行更大样本量和更长随访时间的进一步研究来验证这些发现。
