indigo-carmine and Multiple-Pulmonary-Nodules

Small peripheral pulmonary nodules, which are usually deep-seated with no visual markers on the pleural surface, are often difficult to locate during surgery. At present, CT-guided percutaneous techniques are used to locate pulmonary nodules, but this method has many limitations. Thus, we aimed to evaluate the accuracy and feasibility of electromagnetic navigational bronchoscopy (ENB) with pleural dye to locate small peripheral pulmonary nodules before video-associated thoracic surgery (VATS).. The ENB localisation procedure was performed under general anaesthesia in an operating room. Once the locatable guide wire, covered with a sheath, reached the ideal location, it was withdrawn and 0.2-1.0 mL of methylene blue/indocyanine green was injected through the guide sheath. Thereafter, 20-60 mL of air was instilled to disperse the dye to the pleura near the nodules. VATS was then performed immediately.. Study subjects included 25 patients with 28 nodules. The mean largest diameter of the pulmonary nodules was 11.8 mm (range, 6.0-24.0 mm), and the mean distance from the nearest pleural surface was 13.4 mm (range, 2.5-34.9 mm). After the ENB-guided localisation procedure was completed, the dye was visualised in 23 nodules (82.1%) using VATS. The average duration of the ENB-guided pleural dye marking procedure was 12.6 min (range, 4-30 min). The resection margins were negative in all malignant nodules. Complications unrelated to the ENB-guided localisation procedure occurred in two patients, including one case of haemorrhage and one case of slow intraoperative heart rate.. ENB can be used to safely and accurately locate small peripheral pulmonary nodules and guide surgical resection.. ChiCTR1900021963.

Topics: Bronchoscopy; Coloring Agents; Dimensional Measurement Accuracy; Electromagnetic Fields; Female; Humans; Indigo Carmine; Magnetometry; Male; Methylene Blue; Middle Aged; Multiple Pulmonary Nodules; Preoperative Care; Reproducibility of Results; Solitary Pulmonary Nodule; Surgery, Computer-Assisted; Thoracic Surgery, Video-Assisted

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

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

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