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Updated: Mar 9, 2026
CT-guided Preoperative Localization of Pulmonary Nodules Using a Glucose Test and Tissue Adhesive
Published on: January 30, 2026
Agar blue localization of small pulmonary nodules and ground glass opacifications for thoracoscopic resection
1Departments of Thoracic Surgery, Sharp/Scripps Hospitals, San Diego, California, USA.
Background:
Screening for lung cancer using high resolution computed tomography (CT) has produced encouraging early results. Extremely small nodules and non-palpable areas of opacifications are able to be detected, but pose a challenge to the thoracic surgeon trying to resect these areas.
Methods:
Forty five patients with ground glass opacifications (GGOs) or small pulmonary nodules underwent pre-operative CT-guided placement of methylene blue dyed agar and/or hook wire needle localization prior to thoracoscopic resection. Progel was applied to any intraoperative air leaks observed after successful resection.
Results:
All lesions were successfully excised thoracoscopically. The blue agar aided in localization of these areas and did not affect the histological architecture during pathologic evaluation.
Conclusions:
Careful pre-operative evaluation and planning, including use of selective CT-guided blue agar localization and hook wire placement, may greatly assist in thoracoscopically locating and resecting these often difficult-to-visualize lesions.
