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Electromagnetic Navigation Transthoracic Nodule Localization for Minimally Invasive Thoracic Surgery
Published on: May 4, 2022
Preoperative CT-guided Fiducial Marker Placement for Surgical Localization of Pulmonary Nodules
Shaunagh McDermott1, Nathan E Frenk1, Florian J Fintelmann1
1Divisions of Thoracic Imaging and Intervention (S.M., F.J.F., M.C.P., J.O.S., A.S.) and Thoracic Surgery (H.C.O., A.M.), Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Founders 2, Boston, MA 02114; and the Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (N.E.F.).
Purpose:
To assess the technical success and complication rates of CT-guided fiducial marker placement for the localization of pulmonary nodules and to assess the surgical localization failure rate.
Materials And Methods:
This was a single-center, retrospective analysis of consecutive patients who underwent CT-guided fiducial marker placement procedures between 2014 and 2020. End points included the technical success of the fiducial marker placement, procedural complications, and the surgical localization failure rate. A two-sample t test and a Fisher exact test were used to compare continuous and categorical variables, respectively. Multivariate logistic regression was used to identify independent risk factors for complications.
Results:
A total of 198 preoperative CT-guided fiducial marker placement procedures were performed in 190 patients (mean age, 64 years ± 12 [standard deviation]; 121 women) to localize 205 nodules (mean size, 10 mm ± 4; mean distance to the pleura, 10 mm ± 9). The technical success rate was 98.5% (195 of 198). There were no major complications. A total of 202 nodules were resected during 193 procedures performed 5 days ± 13 after the fiducial marker placement (range, 0-123 days). Surgical localization failure occurred in one patient (0.5%). Of the resected nodules, 146 were lung cancers, 26 nodules were metastases, two were carcinoid tumors, and 28 were benign.
Conclusion:
The CT-guided fiducial marker placement of pulmonary nodules was safe, effective, and resulted in a low surgical localization failure rate.Keywords: CT, Percutaneous, Thorax, Lung.
