Radioguided lung lesion localization: introducing a fluoroscopy system in a SPECT/CT scan

Area of Science:

• Thoracic Surgery
• Nuclear Medicine Imaging
• Pulmonary Oncology

Background:

• Locating small, indistinct, or nonpalpable pulmonary nodules for resection can be challenging with conventional methods.
• Video-assisted thoracoscopic surgery (VATS) may face difficulties in precise nodule identification.
• Novel imaging and localization techniques are needed to improve surgical accuracy for pulmonary nodules.

Purpose of the Study:

• To report the experience and outcomes of radiotracer localization and resection of small pulmonary lesions.
• To evaluate an innovative technique using SPECT/CT with integrated fluoroscopy for CT-guided radiotracer injection.
• To assess the feasibility and efficacy of radioguided surgery for challenging pulmonary nodules.

Main Methods:

• Developed a SPECT/CT system with integrated fluoroscopy for precise CT-guided radiotracer injection.
• Selected patients with nodules difficult to locate via VATS.
• Administered technetium-99m macroaggregated albumin and iodinated contrast via CT guidance.
• Utilized an endoscopic gamma probe during VATS to identify the area of highest radioactivity corresponding to the nodule for resection.

Main Results:

• 37 patients underwent radiotracer injection for nodules with a mean size of 11 mm.
• Nodule types included ground glass (15), solid (12), and partly solid (10).
• The procedure demonstrated a high success rate with no significant adverse events or mortality; 33 patients underwent wedge resection.

Conclusions:

• Radioguided pulmonary nodule localization is a reliable and successful procedure.
• The technique offers minimal complications, reduced failure rates, and no associated mortality or significant morbidity.
• The novel SPECT/CT system with fluoroscopy integration represents a technological advancement for precise radioguided thoracic surgery.