Efficiency of thoracoscopic palpation in localizing small pulmonary nodules

The thoracoscopic localization of small and deep pulmonary nodules can be challenging. We conducted this study to evaluate the efficiency of thoracoscopic palpation in tumor detection.

The subjects of this study were 229 patients with a collective 267 indeterminate pulmonary nodules ≤ 15 mm in diameter, in the outer third of the lung field. The nodules were localized by palpation using the forefinger or a metal suction probe. Based on the distance from the pleura-to-tumor size ratio (D/S), the nodules were classified into group A (D/S = 0), group B (0 < D/S ≤ 1), and group C (D/S > 1).

The median tumor diameter was 10 mm. All 267 nodules were palpable and resected with negative margins via thoracoscopic wedge resection. The majority of the deep nodules had no pleural change (11%, 86%, and 100% in groups A, B, and C, respectively; P < 0.01). The median margins were 15, 16, and 14 mm in groups A, B, and C, respectively. In four patients (1.5%) with relatively short margins (2-7 mm), an additional intraoperative wedge resection was performed.

Thoracoscopic palpation was effective for tumor detection when the nodules were located in the outer third of the lung.