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Clinical significance of spread of lipiodol marking for pulmonary nodules and its influence on surgery

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Abstract

Objective

Computed tomography (CT)-guided lipiodol marking is one of the targeting methods for resecting small pulmonary nodules or ground-glass nodules in video-assisted thoracic surgery (VATS). However, lipiodol spreading during marking has not been assessed, practically. In this study, we examined the clinical significance and the influence of lipiodol spreading on surgery.

Methods

From April 2010 to March 2021, 176 pulmonary nodules in 167 patients were marked with lipiodol under CT guided before VATS. The marking images after lipiodol injection were classified into “Spread” and “non-Spread.” Lung resection was sequentially performed on the same day.

Results

All target nodules were successfully resected in VATS. In the classification of marking images, Spread was 32 (18%), non-Spread was 144 (82%). There was a significant difference in duration of surgery (mean; 138.7 min vs. 118.3 min, p = 0.0496) and amount of bleeding (mean; 32.7 g vs. 11.2 g, p = 0.0173). Provided that limited to the data of wedge resections without intrathoracic pleural adhesion (n = 117), there was no significant difference in duration of surgery (mean; 104.8 min vs. 99.6 min, p = 0.48), amount of bleeding (mean; 4.9 g vs. 5.3 g, p = 0.58). In the multivariate logistic regression analysis, the risk factor of lipiodol spreading was intrathoracic pleural adhesion (odds ratio: 3.16, 95% confidence interval: 1.12–8.97, p = 0.03). There was no relationship between marking image and complication rate.

Conclusions

Lipiodol spreading did not directly influence surgery and complication. However, it was a sign of intrathoracic pleural adhesion, which could lead to increased duration of surgery and amount of bleeding.

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References

  1. Mattioli S, D’Ovidio F, Daddi N, Ferruzzi L, Pilotti V, Ruffato A, et al. Transthoracic endosonography for the intraoperative localization of lung nodules. Ann Thorac Surg. 2005;79(2):443–9.

    Article  PubMed  Google Scholar 

  2. Khereba M, Ferraro P, Duranceau A, Martin J, Goudie E, Thiffault V, et al. Thoracoscopic localization of intraparenchymal pulmonary nodules using direct intracavitary thoracoscopic ultrasonography prevents conversion of VATS procedures to thoracotomy in selected patients. J Thorac Cardiovasc Surg. 2012;144(5):1160–5.

    Article  PubMed  Google Scholar 

  3. Sakamoto T, Takada Y, Endoh M, Matsuoka H, Tsubota N. Bronchoscopic dye injection for localization of small pulmonary nodules in thoracoscopic surgery. Ann Thorac Surg. 2001;72(1):296–7.

    Article  CAS  PubMed  Google Scholar 

  4. Okumura T, Kondo H, Suzuki K, Asamura H, Kobayashi T, Kaneko M, et al. Fluoroscopy-assisted thoracoscopic surgery after computed tomography-guided bronchoscopic barium marking. Ann Thorac Surg. 2001;71(2):439–42.

    Article  CAS  PubMed  Google Scholar 

  5. Miyoshi T, Kondo K, Takizawa H, Kenzaki K, Fujino H, Sakiyama S, et al. Fluoroscopy-assisted thoracoscopic resection of pulmonary nodules after computed tomography-guided bronchoscopic metallic coil marking. J Thorac Cardiovasc Surg. 2006;131(3):704–10.

    Article  PubMed  Google Scholar 

  6. Sato M, Omasa M, Chen F, Sato T, Sonobe M, Bando T, et al. Use of virtual assisted lung mapping (VAL-MAP), a bronchoscopic multispot dye-marking technique using virtual images, for precise navigation of thoracoscopic sublobar lung resection. J Thorac Cardiovasc Surg. 2014;147(6):1813–9.

    Article  PubMed  Google Scholar 

  7. Yanagiya M, Kawahara T, Ueda K, Yoshida D, Yamaguchi H, Sato M. A meta-analysis of preoperative bronchoscopic marking for pulmonary nodules. Eur J Cardiothorac Surg. 2020;58(1):40–50.

    Article  PubMed  Google Scholar 

  8. Dendo S, Kanazawa S, Ando A, Hyodo T, Kouno Y, Yasui K, et al. Preoperative localization of small pulmonary lesions with a short hook wire and suture system: experience with 168 procedures. Radiology. 2002;225(2):511–8.

    Article  PubMed  Google Scholar 

  9. Tseng YH, Lee YF, Hsieh MS, Chien N, Ko WC, Chen JY, et al. Preoperative computed tomography-guided dye injection to localize multiple lung nodules for video-assisted thoracoscopic surgery. J Thorac Dis. 2016;8(Suppl 9):S666–71.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Moon SW, Wang YP, Jo KH, Kwack MS, Kim SW, Kwon OK, et al. Fluoroscopy-aided thoracoscopic resection of pulmonary nodule localized with contrast media. Ann Thorac Surg. 1999;68(5):1815–20.

    Article  CAS  PubMed  Google Scholar 

  11. Nomori H, Horio H, Naruke T, Suemasu K. Fluoroscopy-assisted thoracoscopic resection of lung nodules marked with lipiodol. Ann Thorac Surg. 2002;74(1):170–3.

    Article  PubMed  Google Scholar 

  12. Nakashima S, Watanabe A, Obama T, Yamada G, Takahashi H, Higami T. Need for preoperative computed tomography-guided localization in video-assisted thoracoscopic surgery pulmonary resections of metastatic pulmonary nodules. Ann Thorac Surg. 2010;89(1):212–8.

    Article  PubMed  Google Scholar 

  13. Park CH, Han K, Hur J, Lee SM, Lee JW, Hwang SH, et al. Comparative effectiveness and safety of preoperative lung localization for pulmonary nodules: a systematic review and meta-analysis. Chest. 2017;151(2):316–28.

    Article  PubMed  Google Scholar 

  14. Kim YD, Jeong YJ, Cho JS, Lee JW, Kim HJ, et al. Localization of pulmonary nodules with lipiodol prior to thoracoscopic surgery. Acta Radiol. 2011;52(1):64–9.

    Article  PubMed  Google Scholar 

  15. Miura H, Yamagami T, Tanaka O, Yoshimatsu R, Ichijo Y, Kato D, et al. CT findings after lipiodol marking performed before video-assisted thoracoscopic surgery for small pulmonary nodules. Acta Radiol. 2016;57(3):303–10.

    Article  PubMed  Google Scholar 

  16. Hasegawa T, Kuroda H, Sato Y, Matsuo K, Sakata S, Yashiro H, et al. The utility of indigo carmine and lipiodol mixture for preoperative pulmonary nodule localization before video-assisted thoracic surgery. J Vasc Interv Radiol. 2019;30(3):446–52.

    Article  PubMed  Google Scholar 

  17. Ito K, Shimada J, Shimomura M, Terauchi K, Nishimura M, Yanada M, et al. Safety and reliability of computed tomography-guided lipiodol marking for undetectable pulmonary lesions. Interact Cardiovasc Thorac Surg. 2020;30(4):546–51.

    Article  PubMed  Google Scholar 

  18. Goddard PR, Nicholson EM, Laszlo G, Watt I. Computed tomography in pulmonary emphysema. Clin Radiol. 1982;33(4):379–87.

    Article  CAS  PubMed  Google Scholar 

  19. Kanda Y. Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant. 2013;48(3):452–8.

    Article  CAS  PubMed  Google Scholar 

  20. Kouritas VT, Kefaloyannis E, Tcherveniakov P, Milton R, Chaudhuri N, Brunelli A, et al. Do pleural adhesions influence the outcome of patients undergoing major lung resection? Interact Cardiovasc Thorac Surg. 2017;25(4):613–9.

    Article  PubMed  Google Scholar 

  21. Wang P, Wang S, Liu Z, Sui X, Wang X, Li X, et al. Segmentectomy and wedge resection for elderly patients with stage I non-small cell lung cancer: a systematic review and meta-analysis. J Clin Med. 2022;11(2):294.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Tomiyama N, Yasuhara Y, Nakajima Y, Adachi S, Arai Y, Kusumoto M, et al. CT-guided needle biopsy of lung lesions: a survey of severe complication based on 9783 biopsies in Japan. Eur J Radiol. 2006;59(1):60–4.

    Article  PubMed  Google Scholar 

  23. Horan TA, Pinheiro PM, Araújo LM, Santiago FF, Rodrigues MR. Massive gas embolism during pulmonary nodule hook wire localization. Ann Thorac Surg. 2002;73(5):1647–9.

    Article  PubMed  Google Scholar 

  24. Sakiyama S, Kondo K, Matsuoka H, Yoshida M, Miyoshi T, Yoshida S, et al. Fatal air embolism during computed tomography-guided pulmonary marking with a hook-type marker. J Thorac Cardiovasc Surg. 2003;126(4):1207–9.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Thoracic Surgery, Saiseikai Suita Hospital, 1-2, Kawazonochou, Suita City, Osaka, 564-0013, Japan

    Yoshiaki Matsuura & Motohiro Nishimura

  2. Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan

    Yoshiaki Matsuura & Masayoshi Inoue

  3. Department of Radiology, Saiseikai Suita Hospital, Osaka, 564-0013, Japan

    Kinya Furuichi & Rina Hirohashi

  4. Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan

    Satoshi Teramukai

  5. Graduate School of Nursing for Health Care Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Junichi Shimada

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  1. Yoshiaki Matsuura
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Correspondence to Motohiro Nishimura.

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Matsuura, Y., Nishimura, M., Furuichi, K. et al. Clinical significance of spread of lipiodol marking for pulmonary nodules and its influence on surgery. Gen Thorac Cardiovasc Surg 70, 1015–1021 (2022). https://doi.org/10.1007/s11748-022-01842-2

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  • DOI: https://doi.org/10.1007/s11748-022-01842-2

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