Formosan Journal of Surgery (Jan 2022)
Preoperative computed tomography-guided patent blue localization for pulmonary nodules: A single-center experience
Abstract
Background: The increasing lung cancer screening for asymptomatic adults via computed tomography (CT) has increased the discovery of intermediate pulmonary nodules (PNs) that are small, with a subsolid component, or/and are relatively deeply seated. Pre- or intraoperative localization could be the main modality to identify and localize these target intermediate PNs and facilitate the subsequent surgical resection accordingly. Herein, we present the learning experience of preoperative CT-guided patent blue localization (CTPBL) for PNs in a tertiary hospital and concomitantly conduct an extensive literature review. Materials and Methods: This retrospective study included all patients with PNs undergoing CTPBL before video-assisted thoracoscopic surgery (VATS) resection from January 2019 to August 2020. After completing the consultation and informed consent, preoperative CTPBL was conducted to label these intermediate PNs. Data included the patients' characteristics (sex, age, smoking status, and comorbidities), CTPBL details (PN size and related lobe, dye dilution, puncture times, and time interval from localization to surgery), CT-guided localization complications (pneumothorax, focal parenchyma hemorrhage, hemothorax, and hemoptysis), and intraoperative findings and postoperative pathologic report. The Chi-square tests, Fisher's exact test, and independent t-tests were used to compare the abovementioned variables. Multiple regression analysis was used to identify the potential risk factors for CTPBL-related complications. Results: This study included 54 consecutive patients with 58 PNs, of which 54 had single and 4 had double nodules. The average size of PNs was 0.77 ± 0.31 cm (0.3–2.1); the localization duration and time interval from initial labeling to VATS were 40.4 ± 12.1 min (24–72) and 243.4 ± 94.8 min (118–520), separately. The success rate of preoperative CTPBL was 96.6% (56/58), and all PNs were uneventfully resected via VATS after CTPBL. CTPBL-related complications accounted for 40.7% (22/54), including pneumothorax (22/54), focal parenchyma hemorrhage (11/54), hemothorax (2/54), and hemoptysis (2/54), in order. Based on our multiple regression analysis, the number of PNs is the only potential risk factor related to CTPBL-related hemoptysis (95% confidence interval = −0.545–−0.233; P < 0.001). Conclusion: Based on our learning experience, CTPBL for intermediate PNs could be a safe procedure to label intermediate PNs for thoracoscopic excisional biopsy with a satisfactory success rate. Moreover, our multiple regression analysis demonstrated that patients undergoing repetitive localizations for two PNs were prone to have hemoptysis after CTPBL.
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