CT guided needle localization for video-thoracoscopic resection of pulmonary nodules

Because of its decreased invasiveness Video-Assisted Thoracoscopic Surgery (VATS) has advantages over the traditional open thoracotomy. However, resection of small and subpleural pulmonary nodules via the thoracoscope is often technically difficult or impossible. To facilitate the resection of these difficult-to-palpate lesions, a protocol was established to localize the nodules percutaneously with a fine needle under CT guidance. This method was used in four patients to localize five lung lesions identified radiographically in various lung segments. Of the four patients in the study, three presented with malignancy of the lower extremities (alveolar sarcoma, squamous cell carcinoma, and spindle cell carcinoma). In two of these patients (having alveolar sarcoma and spindle cell carcinoma primaries), the resected pulmonary lesions proved to be metastatic disease. The lesions of the other two patients were nonmalignant (actinomycosis and fibrotic granuloma). The patients with actinomycosis had two distinct lesions which were identified preoperatively with two localizations. All five lesions were able to be localized and resected with clear margins. The patients tolerated the procedures well without complication. VATS with preoperative CT guided needle localization of a subpleural nodule can be a useful diagnostic tool. Its use in therapeutic metastasectomy, nonetheless, remains controversial.