Noninvasive computed tomography-guided marking technique for peripheral pulmonary nodules

Area of Science:

• Thoracic Surgery
• Pulmonary Medicine
• Medical Imaging

Background:

• Accurate localization of small peripheral pulmonary nodules is critical for successful thoracoscopic wedge resection (TWR).
• Minimally palpable nodules present a significant challenge for intraoperative identification.

Purpose of the Study:

• To describe and evaluate a novel computed tomography (CT)-guided marking technique for precisely locating small pulmonary nodules.
• To assess the efficacy and safety of this technique in patients undergoing TWR without puncturing the visceral pleura (VP).

Main Methods:

• Preoperative CT scans were used to guide skin marking over the nodule.
• An indwelling catheter marked the visceral pleura (VP) with gentian violet under CT guidance.
• Nodules were palpated near the mark(s) for subsequent TWR.

Main Results:

• The technique was applied to 54 patients with various lung nodules (mean diameter 10 mm).
• Successful nodule localization was achieved in 98% of cases (53 out of 54 patients).
• The procedure was quick (mean 3.5 min) with minimal complications, including one case of chest wall hematoma.

Conclusions:

• This CT-guided marking technique offers a simple, economic, and effective solution for locating small peripheral pulmonary nodules.
• The method facilitates precise identification during TWR, improving surgical outcomes.
• Avoiding visceral pleura puncture enhances the safety profile of the procedure.