indigo-carmine and Lung-Neoplasms

The Japan Clinical Oncology Group (JCOG) 0802/West Japan Oncology Group (WJOG) 4607L trial has recently reported that in small lung cancer, segmentectomy has a higher overall survival rate than lobectomy, increasing the significance of sublobar resection. However, local recurrence is a major concern after sublobar resection, and an insufficient surgical margin is a significant risk factor for locoregional recurrence. Therefore, since 2014, we have performed virtual-assisted lung mapping (VALMAP), a preoperative bronchoscopic multiple-spot dye-marking technique, using indigo carmine as a preoperative localization technique to identify hardly detectable pulmonary nodules and confirm the adequacy of the surgical margin. However, conventional VAL-MAP (VAL-MAP 1.0) faced some chal-lenges. One issue is that approximately 10% marks were invisible and unidentifiable due to patient factors or technical issues. Another problem was that, in some cases requiring large resection depth, VAL-MAP did not lead to successful resection with adequate surgical margin. Thus, we have invented several novel techniques to solve these issues. VAL-MAP dual staining is a technique using indocyanine green (ICG) as well as indigo carmine that has improved the success rate of marking detection during surgery without causing additional complications. VAL-MAP 2.0 is a proximal mapping technique that involves the use of a coil, enabling three-dimensional mapping and making sublobar resection more accurate, particularly for a deeply located tumor.

Topics: Bronchoscopy; Humans; Indigo Carmine; Lung; Lung Neoplasms; Margins of Excision; Pneumonectomy

For successful nodule localization and appropriate surgical margin distances in pulmonary segmentectomy for patients with lung malignancies, the effectiveness and feasibility of preoperative marking using an indigo carmine and lipiodol mixture remain unclear.. Patients who underwent thoracoscopic pulmonary segmentectomy with (marking group, n = 69) and without (non-marking group, n = 265) preoperative marking at our institution from January 2013 to March 2020 were retrospectively reviewed and compared in terms of surgical outcomes. All markings were performed using a fine needle to percutaneously inject an indigo carmine and lipiodol mixture under the guidance of computed tomography fluoroscopy.. Successful localization was achieved in 66 (96%) patients, of whom 62 (94%) underwent dye pigmentation and 4 (6%) underwent intraoperative fluoroscopy. On images, the marking group showed a significantly longer distance between the lung surface and tumour [mm, 9 (1-17) vs 0 (0-10); P < 0.01] and smaller maximum tumour size [mm, 16 (11-21) vs 17 (13-23); P = 0.03] and consolidation tumour ratio [0.4 (0.3-1) vs 0.8 (0.4-1); P < 0.01] than the non-marking group. Both groups had comparable operative outcomes, perioperative complications, pulmonary function changes and surgical margin distances [mm, 20 (15-21) vs 20 (15-20); P = 0.96] without any local recurrence on the surgical margin. Propensity score-matching analysis also showed similar findings for both groups.. Thoracoscopic pulmonary segmentectomy with preoperative marking using an indigo carmine and lipiodol mixture may be an acceptable therapeutic option for small malignancies located in deep lung parenchyma.

Topics: Ethiodized Oil; Humans; Indigo Carmine; Lung; Lung Neoplasms; Margins of Excision; Pneumonectomy; Retrospective Studies; Thoracic Surgery, Video-Assisted

Topics: Coloring Agents; Ethiodized Oil; Humans; Indigo Carmine; Lung; Lung Neoplasms; Pneumonectomy

Virtual-assisted lung mapping is a bronchoscopic multiple dye marking technique that facilitates sublobar lung resections for unidentifiable pulmonary tumors. Marking failure reportedly occurs in 10% of cases. To overcome this limitation, we developed indocyanine green virtual-assisted lung mapping that uses indocyanine green in addition to indigo carmine. Here, we report our initial experience of indocyanine green virtual-assisted lung mapping.

Topics: Bronchoscopy; Coloring Agents; Humans; Indigo Carmine; Indocyanine Green; Lung; Lung Neoplasms; Tomography, X-Ray Computed

Small pulmonary nodule localization via an endobronchial route is safe and has fewer complications than that with the transthoracic needle approach, but accurate marking without a navigation system remains challenging. We aimed to evaluate the safety and efficacy of endobronchial dye marking using conventional bronchoscopy guided by cone-beam computed tomography-derived augmented fluoroscopy (CBCT-AF) for small pulmonary nodules.. We retrospectively reviewed the clinical records of 61 nodules in 51 patients who underwent preoperative CBCT-AF-guided bronchoscopic dye marking, followed by thoracoscopic resection, between July 2018 and March 2019.. The median nodule size was 8.6 mm [interquartile range (IQR) 7.0-11.8 mm], and the median distance from the pleural space was 15.4 mm (IQR 10.6-23.1 mm). All nodules were identifiable on CBCT images and annotated for AF. The median bronchoscopy duration was 8.0 min (IQR 6.0-11.0 min), and the median fluoroscopy duration was 2.2 min (IQR 1.2-4.0 min). The median radiation exposure (expressed as the dose area product) was 2337.2 µGym. Bronchoscopic dye marking under CBCT-AF guidance before thoracoscopic surgery was safely conducted with satisfactory outcomes in our initial experience.

Topics: Bronchoscopy; Cone-Beam Computed Tomography; Female; Fluorescent Dyes; Fluoroscopy; Humans; Indigo Carmine; Indocyanine Green; Lung Neoplasms; Male; Middle Aged; Multimodal Imaging; Multiple Pulmonary Nodules; Optical Imaging; Retrospective Studies; Solitary Pulmonary Nodule; Thoracic Surgery, Video-Assisted; Thoracoscopy

To evaluate the safety and efficacy of a mixture of indigo carmine and lipiodol (MIL) as a marker of pulmonary nodule before video-assisted thoracic surgery (VATS).. One hundred sixty-eight sessions of pulmonary marking were performed using MIL before VATS for 184 nodules (mean size, 1.2 ± 0.6 cm; range, 0.3-3.6 cm) on 157 patients (83 men and 74 women; median age, 66 years). The mean distance between the lung surface and the nodule was 0.8 ± 0.7 cm (range, 0-3.9 cm). MIL was injected near the nodule using a 23-gauge needle. Mean number of 1.2 ± 0.4 (range, 1-3) punctures were performed in a session for the target nodules, with mean number of 1.1 ± 0.3 (range, 1-3). Successful targeting, localization, and VATS were defined as achievement of lipiodol accumulation at the target site on computed tomography, detection of the nodule in the operative field by fluoroscopy or visualization of dye pigmentation, and complete resection of the target nodule with sufficient margin, respectively.. The successful targeting rate was 100%, and the successful localization rate was 99.5%, with dye pigmentation for 160 nodules (87.0%) and intraoperative fluoroscopy for 23 nodules (12.5%). Successful VATS was achieved for 181 nodules (98.4%). Two nodules (1.1%) were not resectable, and surgical margin was positive in 1 nodule (0.5%). Complications requiring interventions occurred in 5 sessions (3.0%) and included pneumothorax with chest tube placement (n = 3) and aspiration (n = 2). No complication related to the injected MIL occurred.. MIL was safe and useful for preoperative pulmonary nodule marking.

Topics: Adult; Aged; Aged, 80 and over; Coloring Agents; Contrast Media; Ethiodized Oil; Female; Humans; Indigo Carmine; Lung Neoplasms; Male; Margins of Excision; Middle Aged; Multiple Pulmonary Nodules; Predictive Value of Tests; Preoperative Care; Retrospective Studies; Risk Factors; Solitary Pulmonary Nodule; Thoracic Surgery, Video-Assisted; Tomography, X-Ray Computed; Treatment Outcome

To retrospectively evaluate the feasibility of CT fluoroscopy-guided percutaneous marking using a 25-gauge needle and indigo carmine before video-assisted thoracoscopic surgery (VATS) for small lung lesions.. 21 patients, 14 males and 7 females, with a median age of 69 years (range, 40-79), underwent CT fluoroscopy-guided percutaneous VATS marking using a 25-gauge, 70-mm needle and 1.5-ml indigo carmine. The mean diameter of the lung lesions was 14 mm (range, 6-27). We evaluated the technical success rate, surgical success rate and complications related to this procedure by reviewing medical records and images. Technical success was defined as completion of this procedure. Surgical success was defined as resection of the target lesion with negative margins on pathological examination after VATS. Complications that required advanced levels of care were classified as major complications, and the remaining complications were considered minor.. The technical success rate was 100%. In all cases, VATS was successfully performed as planned, and the target lesion was resected with negative margins on pathological examination after VATS. Thus, the surgical success rate was 100%. Mild pneumothorax was found in two cases, but further treatment was not required. The minor complication rate was 9.5% (2/21), and major complication rate was 0%. Only two patients (9.5%) complained of slight pain upon puncture, but local anaesthesia was not required.. Percutaneous CT fluoroscopy-guided VATS marking using a 25-gauge needle without local anaesthesia appears feasible and safe. Advances in knowledge: This technique expands a possibility of the CT-guided marking.

Topics: Adenocarcinoma; Adult; Aged; Coloring Agents; Feasibility Studies; Female; Fluoroscopy; Humans; Indigo Carmine; Lung Neoplasms; Male; Middle Aged; Needles; Radiography, Interventional; Retrospective Studies; Thoracic Surgery, Video-Assisted; Tomography, X-Ray Computed; Treatment Outcome

Virtual-assisted lung mapping is a preoperative bronchoscopic multi-spot dye-marking technique. This study aimed to examine the efficacy of virtual-assisted lung mapping for obtaining sufficient surgical margins in sublobar lung resection.. The multicenter, prospective, single-arm study was conducted from September 2016 to July 2017 in 19 registered centers. Patients who required sublobar lung resection and careful determination of resection margins underwent virtual-assisted lung mapping followed by thoracoscopic surgery. Successful resection was defined as resection of the lesion with margins greater than the lesion diameter or 2 cm using the preoperatively planned resection without additional resection. We defined the primary goal of the study as achieving successful resection in 95% of lesions.. The resection of 203 lesions (average diameter, 9.6 ± 5.3 mm) was intended in 153 patients. The lesions included pure and mixed ground-glass nodules (75 [35.9%] and 36 [17.2%], respectively), solid nodules (91 [43.5%]), and others (7 [3.3%]). Surgical procedures included wedge resection (131, 71.2%), segmentectomy (51, 27.7%), and others (2, 1.1%). Successful resection was achieved in 178 lesions (87.8% [95% confidence interval, 82.4-91.9%]), and virtual-assisted lung mapping markings successfully aided in the identification of 190 lesions (93.6% [95% confidence interval, 89.3-96.5%]). Multivariable analysis showed that the most significant factor affecting resection success was the depth of the necessary resection margin (P = .0072).. This study showed that virtual-assisted lung mapping has reasonable efficacy, although the successful resection rate did not reach the primary goal. The depth of the required margin was the most significant factor leading to resection failure.

Topics: Adult; Aged; Bronchoscopy; Coloring Agents; Female; Humans; Indigo Carmine; Japan; Lung Neoplasms; Male; Margins of Excision; Middle Aged; Multiple Pulmonary Nodules; Pneumonectomy; Preoperative Care; Prospective Studies; Solitary Pulmonary Nodule; Thoracic Surgery, Video-Assisted; Tomography, X-Ray Computed; Treatment Outcome

We have developed a novel bronchoscopic multiple marking technique to assist resection of hardly palpable lung tumors. Because 3-dimensional virtual images were used and multiple markings made on the lung surface to provide "geometric" information, we termed this technique "virtual assisted lung mapping" (VAL-MAP). The safety and efficacy of VAL-MAP were evaluated.. Virtual bronchoscopy was used to select 2 to 4 appropriate bronchial branches for marking. Bronchoscopy was conducted with the patient under local anesthesia. A metal-tip catheter was inserted into a selected bronchus and advanced to the pleura. The location of the catheter tip was fluoroscopically confirmed, and 1 mL of indigo carmine was injected. This procedure was repeated to complete all the planned markings. Post-VAL-MAP computed tomography was used to visualize the localization of the multiple markings on 3-dimensional virtual images, which were used as references in the subsequent operation.. Of the 95 marking attempts made for 37 tumors in 30 patients, 88 (92.6%) were identified and contributed to the surgery. No clinically evident complications were associated with the procedure. A total of 15 wedge resections and 18 segmentectomies were thoracoscopically conducted, with a successful resection rate of 100%. Multiple markings of the VAL-MAP were complementary, enabling us to achieve complete resection even when 1 of the markings failed. The markings were visible even on interlobar fissures, at the apex, and on the diaphragm, which conventional percutaneous marking can hardly reach.. VAL-MAP was safely conducted with satisfactory outcomes in our early experience. Additional confirmation of its safety and efficacy is necessary.

Topics: Aged; Bronchoscopy; Coloring Agents; Female; Humans; Image Interpretation, Computer-Assisted; Imaging, Three-Dimensional; Indigo Carmine; Lung Neoplasms; Male; Middle Aged; Pneumonectomy; Predictive Value of Tests; Surgery, Computer-Assisted; Thoracoscopy; Tomography, X-Ray Computed; Treatment Outcome; Tumor Burden

While performing thoracoscopic wedge resection of the lung, the location of the lesion is generally identified by visual inspection or palpation. When difficulty in identification of the lesion by thoracoscopy is anticipated, preoperative marking is performed. However, complications and technical difficulties plague current marking techniques. To overcome this problem, we designed a new, safe and easy marking technique that avoids pleural puncture, called the intrathoracic stamping method.

Topics: Coloring Agents; Humans; Indigo Carmine; Lung; Lung Neoplasms; Multiple Pulmonary Nodules; Palpation; Pleura; Predictive Value of Tests; Preoperative Care; Solitary Pulmonary Nodule; Thoracic Surgery, Video-Assisted; Tomography, X-Ray Computed; Wounds and Injuries

Topics: Coloring Agents; Humans; Indigo Carmine; Lung; Lung Neoplasms; Multiple Pulmonary Nodules; Pleura; Solitary Pulmonary Nodule; Thoracic Surgery, Video-Assisted; Wounds and Injuries

A new method of marking small pulmonary nodules situated deep within the visceral pleura using a transbronchial approach has been developed. Once the tip of the sheath catheter has passed the tumor and reached the visceral pleura, as confirmed by computed tomography fluoroscopy, indigo carmine is injected through a bronchoscope into the lung parenchyma just beneath the visceral pleura. No complications related to the procedure were experienced. The dye-marking procedure enabled the nodules to be precisely located. This technique can provide appropriate guidance when used in conjunction with video-assisted thoracic operations.

Topics: Bronchoscopy; Humans; Indigo Carmine; Injections, Intralesional; Lung Neoplasms; Thoracic Surgery, Video-Assisted; Tomography, X-Ray Computed

Fifteen patients underwent computed tomography (CT)-guided contrast material localization of pulmonary nodules, with barium and indigo carmine stain used in five patients, iodized oil and indigo carmine stain in five, and water-soluble contrast material and indigo carmine stain in five before fluoroscopy-assisted thoracoscopic resection. Contrast material localization was successful in all cases, and the surgeon confirmed accurate localization, CT-guided contrast material localization is simple and useful for thoracoscopic resection.

Topics: Adult; Aged; Barium Sulfate; Contrast Media; Endoscopes; Equipment Design; Female; Fluoroscopy; Humans; Indigo Carmine; Lung; Lung Neoplasms; Male; Middle Aged; Prospective Studies; Solitary Pulmonary Nodule; Thoracoscopes; Tomography, X-Ray Computed

Topics: Adenoma; Animals; Blood Cell Count; Body Weight; Diet; Female; Indigo Carmine; Indoles; Lung Neoplasms; Male; Mice; Organ Size; Time Factors