Marking of Small Pulmonary Nodules Before Thoracoscopic Resection: Injection of Lipiodol Under CT-fluoroscopic Guidance

Kawanaka, Koichi; Nomori, Hiroaki; Mori, Takeshi; Ikeda, Koei; Ikeda, Osamu; Tomiguchi, Seiji; Yamashita, Yasuyuki

doi:10.1016/j.acra.2008.07.012

« Previous Next »Academic Radiology
Volume 16, Issue 1 , Pages 39-45, January 2009

Marking of Small Pulmonary Nodules Before Thoracoscopic Resection:

Injection of Lipiodol Under CT-fluoroscopic Guidance

Koichi Kawanaka, MD
- Department of Diagnostic Radiology, Graduate School of Medicine, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
- Address correspondence to: K.K.
Hiroaki Nomori, MD, PhD
- Department of Thoracic Surgery, Graduate School of Medicine, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
Takeshi Mori, MD, PhD
- Department of Thoracic Surgery, Graduate School of Medicine, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
Koei Ikeda, MD, PhD
- Department of Thoracic Surgery, Graduate School of Medicine, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
Osamu Ikeda, MD
- Department of Diagnostic Radiology, Graduate School of Medicine, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
Seiji Tomiguchi, MD, PhD
- School of Health Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
Yasuyuki Yamashita, MD, PhD
- Department of Diagnostic Radiology, Graduate School of Medicine, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan

Received 6 June 2008; accepted 11 July 2008.

Rationale and Objectives

The aim of the present study was to examine the usefulness and record the complications of preoperative lipiodol marking using computed tomographic (CT) fluoroscopy for the intraoperative localization of 107 pulmonary nodules.

Methods

Lipiodol marking was performed under CT fluoroscopic guidance in 65 patients with 107 nodules. Of these, 65 (60.7%) were nodules with ground-glass opacity, and 42 were solid nodules on CT images. All nodules were marked with 0.3 to 0.5 mL lipiodol under CT fluoroscopic guidance 1 or 3 days before or on the day of surgery. At surgery, marked nodules were grasped with ring-shaped forceps under a C-arm fluoroscope and resected. Postoperatively, all 55 patients with malignant tumors (n = 78) were followed by computed tomography at 3-month intervals to detect needle tract or pleural recurrence.

Results

All 107 nodules were marked with lipiodol; under the C-arm fluoroscope, they appeared as radiopaque spots. On postprocedural computed tomography, pneumothorax occurred in 20 patients (31%); its incidence was higher in patients with lung emphysema surrounding the nodules (P = .09), three of whom required tube drainage. Computed tomography detected pulmonary hemorrhage in 10 patients (15%); it was more frequent in patients with deep than shallow nodules (≥6 cm from the pleural surface and <6 cm from the pleural surface, respectively; P = .04). No patients presented with recurrence in needle tracts or on the pleural surface during a median postoperative follow-up of 14 months.

Conclusion

Lipiodol marking under CT fluoroscopic guidance is a useful and safe procedure for the intraoperative localization of ground-glass opaque and/or small, deep, solid nodules.

Key Words: Preoperative procedure, thoracic surgery, CT fluoroscopy, marking