Spot On: Indocyanine Green-Soaked Fiducial Markers for Lung Nodules Prior to Thoracic Surgery

Peripheral pulmonary lesions (PPLs) are increasingly identified and often require a tissue diagnosis to guide treatment. Although a surgical resection may combine diagnosis and treatment, it may lead to excessive healthy tissue being removed if the lesion is difficult to localize. Bronchoscopic PPL marking before surgery facilitates this process, but it is limited by current technologies. Advances in procedural techniques may improve this process.

What is the impact of using indocyanine green-soaked fiducial markers (ICG-Fs) to mark PPLs before surgery compared with unmarked resected PPLs?

A retrospective review of patients from 4 institutions with PPLs undergoing bronchoscopy with ICG-F marking (54 nodules) before resection were compared with unmarked nodules (63 nodules). Demographic data, nodule characteristics, procedural and surgical information, and final pathology results were obtained.

Demographics were similar between the groups. PPLs were smaller in the ICG-F marked group (axial: ICG-F marked: 14.39 ± 5.39 vs unmarked: 20.31 ± 14.24 mm; P = .0036; coronal: ICG-F marked: 12.66 ± 5.13 vs unmarked: 16.43 ± 10.51 mm; P = .0214). All ICG-F marked lesions were visible with illumination at surgery immediately after bronchoscopy or up to 13 days later. Mean weight (58 ± 77 vs 145 ± 80 g; P < .001) and size (9.07 ± 6.0 × 4.73 ± 3.6 × 2.42 ± 1.23 vs 14.63 ± 6.08 × 8.70 ± 4.36 × 4.08 ± 1.94 mm; P < .001 for all) of the resected ICG-F specimens were significantly decreased compared with unmarked PPLs. Operative time was increased in the ICG-F marked group (165 ± 53 vs 136 ± 43 minutes; P = .0021).

Our findings indicate that ICG-F is a safe and accurate procedure to facilitate lung sparing surgery of otherwise undetectable PPLs immediately after bronchoscopic placement or up to 13 days later.