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Safety and feasibility comparison between three different CT-guided localization techniques under systemic approach

Wen-Chi Hsu1, Kuei-An Chen1, Kuang-Tse Pan1

  • 1Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Taiwan; Chang Gung University, Taiwan.

European Journal of Radiology
|January 31, 2024
PubMed
Summary

CT-guided localization for lung nodules is safe and feasible. Wire localization suits central lesions, while dye-tattooing is better for peripheral ones, offering distinct safety and persistence profiles.

Keywords:
ICGLocalizationMethylene blueNavigationWire

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Area of Science:

  • Pulmonology
  • Thoracic Surgery
  • Medical Imaging

Background:

  • Increasing identification of sub-centimeter indeterminate lung nodules due to lung cancer screening.
  • Challenges in obtaining tissue diagnosis for small lung lesions.
  • CT-guided navigation and surgical resection as a solution for lesion localization.

Purpose of the Study:

  • To compare the safety and feasibility of CT-guided wire and dye-tattoo localization techniques.
  • Evaluate procedure details, navigation outcomes, and complication rates.
  • Determine optimal techniques for different lung lesion locations.

Main Methods:

  • Retrospective study of 418 patients undergoing single CT-guided localization for lung lesions (September 2019 - August 2021).
  • Comparison of wire localization versus dye-tattooing (including ICG) techniques.
  • Analysis of procedure success, lesion characteristics, and adverse events.

Main Results:

  • Wire localization predominantly used for perihilar lesions; dye-tattooing for peripheral.
  • Wire localization associated with higher rates of pneumothorax and pulmonary hemorrhage.
  • Indocyanine green (ICG) dye-tattooing demonstrated significantly longer lesion localization persistence.

Conclusions:

  • CT-guided localization techniques are safe and effective for indeterminate lung nodules.
  • Wire localization is suitable for central lesions, requiring careful fixation and monitoring.
  • Dye-tattooing techniques are preferable for peripheral lesions, with ICG offering extended localization duration.