Complications Associated with the Percutaneous Insertion of Fiducial Markers in the Thorax
Radiosurgery requires precise lesion localization. Fiducial markers enable lesion tracking, but complications from insertion may occur. The purpose of this study was to describe complications of fiducial marker insertion into pulmonary lesions.
Materials and Methods
Clinical and imaging records of 28 consecutive patients with 32 lung nodules or masses who underwent insertion of a total of 59 fiducial markers before radiosurgery were retrospectively reviewed.
Eighteen patients (67%) developed a pneumothorax, and six patients (22%) required a chest tube. The rates of pneumothorax were 82% and 40%, respectively, when 18-gauge and 19-gauge needles were used for marker insertion (P = 0.01). Increased rate of pneumothorax was also associated with targeting smaller lesions (P = 0.03) and tumors not in contact with the pleural surface (P = 0.04). A total of 11 fiducials (19%) migrated after insertion into the pleural space (10 markers) or into the airway (1 marker). Migration was associated with shorter distances from pleura to the marker deposition site (P = 0.04) and with fiducial placement outside of the target lesion (P = 0.03).
Fiducial marker placement into lung lesions is associated with a high risk of pneumothorax and a risk of fiducial migration.
- Uematsu, M, Shioda, A, Tahar, K (1998) Focal, high dose, and fractionated modified stereotactic radiation therapy for lung carcinoma patients: a preliminary experience. Cancer 82: pp. 1062-1070 CrossRef
- Murphy, MJ (2004) Tracking moving organs in real time. Semin Radiat Oncol 14: pp. 91-100 CrossRef
- Shirato, H, Shimizu, S, Kitamura, K (2007) Organ motion in image-guided radiotherapy: lessons from real-time tumor-tracking radiotherapy. Int J Clin Oncol 12: pp. 8-16 CrossRef
- Shirato, J, Harada, T, Harabayashi, T (2003) Feasibility of insertion/implantation of 2.0 mm diameter gold internal fiducial markers for precise setup and real-time tumor tracking in radiotherapy. Int J Radiat Oncol Biol Phys 56: pp. 240-247
- Collins J, Bloom A, Dai C et al (2007) CT-guided gold fiducial seed placement for respiratory gated external radiation therapy in thoracic and liver lesions. In: Presented at the annual meeting of the Cardiovascular and Interventional Radiological Society of Europe, Athens, Greece, September 8–12
- Kothary, N, Heit, JJ, Louie, JD (2009) Safety of percutaneous fiducial marker implantation for image-guided radiation therapy. J Vasc Interv Radiol 20: pp. 235-239 CrossRef
- Yousefi, S, Collins, BT, Reichner, CA (2007) Complications of thoracic computed tomography-guided fiducial placement for the purpose of stereotactic biopsy. Clin Lung Cancer 8: pp. 252-256 CrossRef
- Geraghty, PR, Kee, ST, McFarlane, G (2003) CT-guided transthoracic needle aspiration biopsy of pulmonary nodules: needle size and pneumothorax rate. Radiology 229: pp. 475-481 CrossRef
- Westcott, JL (1998) Percutaneous transthoracic needle biopsy. Radiology 169: pp. 593-601
- Cardella, JF, Bakal, CW, Bertino, RE (2003) Quality improvement guidelines for image-guided percutaneous biopsy in adults. J Vasc Interv Radiol 14: pp. S227-S230 CrossRef
- Complications Associated with the Percutaneous Insertion of Fiducial Markers in the Thorax
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CardioVascular and Interventional Radiology
Volume 33, Issue 6 , pp 1186-1191
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- 1. Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, Room M-361, San Francisco, CA, 94143, USA