Surgical Endoscopy And Other Interventional Techniques

, Volume 20, Issue 9, pp 1341–1347

Intrathoracoscopic localization techniques

Review of literature
  • D. Sortini
  • C. Feo
  • K. Maravegias
  • P. Carcoforo
  • E. Pozza
  • A. Liboni
  • A. Sortini
Review article

Abstract

Background

Several techniques for localizing pulmonary nodules have been described, but the advantages and disadvantages of each method remain unclear. We reviewed ultrasound, endofinger, finger palpation and wait and watch, radioguided, vital dye, fluoroscopic, agar marking, and needle wire methods for localizing pulmonary nodules.

Methods

Original, peer-reviewed, and full-length articles in English were searched with PubMed and ISI Web of Sciences. Case reports and case series with less than 10 patients were excluded.

Results

All localization techniques showed good reliability, but some carry a high rate of major or minor complications and drawbacks.

Conclusion

No ideal localization technique is available; thus, the choice still depends on surgeon’s preference and local availability of both specialists and instruments.

Keywords

Thoracic surgery Lung cancer Surgery Ultrasound Radiology Lung cancer 

References

  1. 1.
    Akamatsu H, Sunamori M, Katsuo K (2000) Thoracoscopic lung resection for extremely small nodular lesions using simultaneous intraoperative real-time computed tomography. Thorac Cardiovasc Surg 48: 34–35PubMedCrossRefGoogle Scholar
  2. 2.
    Baldwin DR, Eaton T, Kolbe J, Christmas T, Milne D, Mercer J, Steele E, Garrett J, Wilsher ML, Wells AU (2002) Management of solitary pulmonary nodules: how do thoracic computed tomography and guided fine needle biopsy influence clinical decisions? Thorax 57: 817–822PubMedCrossRefGoogle Scholar
  3. 3.
    Bernard A (1996) Resection of pulmonary nodules using video-assisted thoracic surgery. The Thorax Group. Ann Thorac Surg 61: 202–204PubMedCrossRefGoogle Scholar
  4. 4.
    Boni G, Bellina CR, Grosso M, Lucchi M, Manca G, Ambrogi MC, Volterrani D, Menconi G, Melfi FM, Gonfiotti A, et al. (2000) Gamma probe-guided thoracoscopic surgery of small pulmonary nodules. Tumori 86: 364–366PubMedGoogle Scholar
  5. 5.
    Cardillo G, Regal M, Sera F, Di Martino M, Carbone L, Facciolo F, Martelli M (2003) Videothoracoscopic management of the solitary pulmonary nodule: a single-institution study on 429 cases. Ann Thorac Surg 75: 1607–1611PubMedCrossRefGoogle Scholar
  6. 6.
    Chella A, Lucchi M, Ambrogi MC, Menconi G, Melfi FM, Gonfiotti A, Boni G, Angeletti CA (2000) A pilot study of the role of TC-99 radionuclide in localization of pulmonary nodular lesions for thoracoscopic resection. Eur J Cardiothorac Surg 18: 17–21PubMedCrossRefGoogle Scholar
  7. 7.
    Choi BG, Kim HH, Kim BS, Kim KT, Shinn KS, Moon SW (1998) Pulmonary nodules: CT-guided contrast material localization for thoracoscopic resection. Radiology 208: 399–401PubMedGoogle Scholar
  8. 8.
    Ciriaco P, Negri G, Puglisi A, Nicoletti R, Del Maschio A, Zannini P (2004) Video-assisted thoracoscopic surgery for pulmonary nodules: rationale for preoperative computed tomography-guided hookwire localization. Eur J Cardiothorac Surg 25: 429–433PubMedCrossRefGoogle Scholar
  9. 9.
    Daniel TM, Altes TA, Rehm PK, Williams MB, Jones DR, Stolin AV, Gay SB (2004) A novel technique for localization and excisional biopsy of small or ill-defined pulmonary lesions. Ann Thorac Surg 77: 1756–1762PubMedCrossRefGoogle Scholar
  10. 10.
    De Kerviler E, Gossot D, Celerier M, Frija J (1998) Limitations of intraoperative sonography for the localization of pulmonary nodules during thoracoscopy. Am J Roentgenol 170: 214–215Google Scholar
  11. 11.
    De Kerviler E, Gossot D, Frija J (1996) Localization techniques for the thoracoscopic resection of pulmonary nodules. Int Surg 8: 241–244Google Scholar
  12. 12.
    Dendo S, Kanazawa S, Ando A, Hyodo T, Kouno Y, Yasui K, Mimura H, Akaki S, Kuroda M, Shimizu N, et al. (2002) Preoperative localization of small pulmonary lesions with a short hook wire and suture system: experience with 168 procedures. Radiology 225: 511–518PubMedGoogle Scholar
  13. 13.
    Dewan NA, Gupta NC, Redepenning LS (1993) Diagnostic efficacy of PET-FDG imaging in solitary pulmonary nodules: potential role in evaluation and management. Chest 104: 997–1002PubMedGoogle Scholar
  14. 14.
    Dewan NA, Shehan CJ, Reeb SD, Gobar LS, Scott WJ, Ryschon K (1997) Likelihood of malignancy in a solitary pulmonary nodule. Comparison of Bayesian analysis and results of FDG-PET scan. Chest 112: 416–422PubMedGoogle Scholar
  15. 15.
    Dowling RD, Keenan RJ, Ferson PF, Landreneau RJ (1993) Video-assisted thoracoscopic resection of pulmonary metastases. Ann Thorac Surg 56: 772–775PubMedCrossRefGoogle Scholar
  16. 16.
    Dowling RD, Landreneau RJ, Miller DL (1998) Video-assisted thoracoscopic surgery for resection of lung metastases. Chest 113: 2s–5sPubMedGoogle Scholar
  17. 17.
    Ginsberg MS, Griff SK, Go BD, Yoo HH, Schwartz LH, Panicek DM (1999) Pulmonary nodules resected at video-assisted thoracoscopic surgery: etiology in 426 patients. Radiology 213: 277–282PubMedGoogle Scholar
  18. 18.
    Greenfield AL, Steiner RM, Liu JB, Cohn HE, Goldberg BB, Rawool NM, Merton DA (1997) Sonographic guidance for the localization of peripheral pulmonary nodules during thoracoscopy. Am J Roentgenol 168: 1057–1060Google Scholar
  19. 19.
    Gupta NC, Maloof J, Gunel E (1996) Probability of malignancy in solitary pulmonary nodules using fluorine-18-FDG and PET. J Nucl Med 37: 943–948PubMedGoogle Scholar
  20. 20.
    Hanninen EL, Langrehr J, Raakow R, Rottgen R, Schmidt S, Pech M, Ricke J, Felix R (2004) Computed tomography-guided pulmonary nodule localization before thoracoscopic resection. Acta Radiol 45: 284–288PubMedCrossRefGoogle Scholar
  21. 21.
    Hida Y, Kato H, Nishibe T, Narita Y, Okubo T, Takahashi T, Doke M, Okushiba S, Motohara T, Sasaki S (1996) Value of intraoperative intrathoracic ultrasonography during video-assisted thoracoscopic pulmonary resection. Surg Laparosc Endosc 6: 472–475PubMedCrossRefGoogle Scholar
  22. 22.
    Horan TA, Pinheiro PM, Araujo LM, Santiago FF, Rodrigues MR (2002) Massive gas embolism during pulmonary nodule hook wire localization. Ann Thorac Surg 73: 1647–1649PubMedCrossRefGoogle Scholar
  23. 23.
    Kanazawa S, Ando A, Yasui K, Mitani M, Hiraki Y, Shimizu N, Hamanaka D, Kojima K (1998) Localization of pulmonary nodules for thoracoscopic resection: experience with a system using a short hookwire and suture. Am J Roentgenol 170: 332–334Google Scholar
  24. 24.
    Katada K, Kato R, Anno H, Ogura Y, Koga S, Ida Y, Sato M, Nonomura K (1996) Guidance with real-time CT fluoroscopy: early clinical experience. Radiology 200: 851–856PubMedGoogle Scholar
  25. 25.
    Landreneau RJ, Mack MJ, Dowling RD, Luketich JD, Keenan RJ, Ferson PF, Hazelrigg SR (1998) The role of thoracoscopy in lung cancer management. Chest 113: 6S–12SPubMedGoogle Scholar
  26. 26.
    Lardinois D, Weder W, Hany TF, Kamel EM, Korom S, Seifert B, von Schulthess GK, Steinert HC (2003) Staging of non-small-cell lung cancer with integrated positron-emission tomography and computed tomography. N Engl J Med 348: 2500–2507PubMedCrossRefGoogle Scholar
  27. 27.
    Lenglinger FX, Schwarz CD, Artmann W (1994) Localization of pulmonary nodules before thoracoscopic surgery: value of percutaneous staining with methylene blue. Am J Roentgenol 163: 297–300Google Scholar
  28. 28.
    Liptay MJ, Masters GA, Winchester DJ, Edelman BL, Garrido BJ, Hirschtritt TR, Perlman RM, Fry WA (2000) Intraoperative radioisotope sentinel lymph node mapping in non-small cell lung cancer. Ann Thorac Surg 70: 384–389PubMedCrossRefGoogle Scholar
  29. 29.
    Little AG (2002) Sentinel node biopsy for staging lung cancer. Surg Clin North Am 82: 561–571PubMedCrossRefGoogle Scholar
  30. 30.
    Little AG, DeHoyos A, Kirgan DM, Arcomano TR, Murray KD (1999) Intraoperative lymphatic mapping for non-small cell lung cancer: the sentinel node technique. J Thorac Cardiovasc Surg 117: 220–224PubMedCrossRefGoogle Scholar
  31. 31.
    Liu HP, Lin PJ, Hsieh MJ, Chang JP, Chang CH (1995) Application of thoracoscopy for lung metastases. Chest 107: 266–268PubMedGoogle Scholar
  32. 32.
    Lizza N, Eucher P, Haxhe JP, De Wispelaere JF, Johnson PM, Delaunois L (2001) Thoracoscopic resection of pulmonary nodules after computed tomographic-guided coil labeling. Ann Thorac Surg 71: 986–988PubMedCrossRefGoogle Scholar
  33. 33.
    Loscertales Congregado M, Giron Arjona JC, Jimenez Merchan R, Arroyo Tristan A, Arenas Linares C, Ayarra Jarne J, Loscertales J (2002) Usefulness of video-assisted thoracoscopy for the diagnosis of solitary pulmonary nodules. Arch Bronconeumol 38: 415–420Google Scholar
  34. 34.
    Mack MJ, Hazelrigg SR, Landreneau RJ, Acuff TE (1993) Thoracoscopy for the diagnosis of the indeterminate solitary pulmonary nodule. Ann Thorac Surg 56: 825–830PubMedCrossRefGoogle Scholar
  35. 35.
    Mack MJ, Shennib H, Landreneau RJ, Hazelrigg SR (1993) Techniques for localization of pulmonary nodules for thoracoscopic resection. J Thorac Cardiovasc Surg 106: 550–553PubMedGoogle Scholar
  36. 36.
    Matsumoto S, Hirata T, Ogawa E, Fukuse T, Ueda H, Koyama T, Nakamura T, Wada H (2004) Ultrasonographic evaluation of small nodules in the peripheral lung during video-assisted thoracic surgery (VATS). Eur J Cardiothorac Surg 26: 469–473PubMedCrossRefGoogle Scholar
  37. 37.
    McConnell PI, Feola GP, Meyers RL (2002) Methylene blue-stained autologous blood for needle localization and thoracoscopic resection of deep pulmonary nodules. J Pediatr Surg 37: 1729–1731PubMedCrossRefGoogle Scholar
  38. 38.
    Menconi GF, Ambrogi MC, Melfi FM, Dini P, Davini F, Goletti O, Roggi G, Angeletti CA (1998) Endothoracic sonography with color Doppler availability during video assisted thoracic surgery (videothoracoscopic operative staging with ultrasound color Doppler) for lung cancer staging. Surg Endosc 12: 816–819PubMedCrossRefGoogle Scholar
  39. 39.
    Miller JJ (2005) Invited commentary. Ann Thorac Surg 79: 262CrossRefGoogle Scholar
  40. 40.
    Moon SW, Wang YP, Jo KH, Kwack MS, Kim SW, Kwon OK, Jang HS (1999) Fluoroscopy-aided thoracoscopic resection of pulmonary nodule localized with contrast media. Ann Thorac Surg 68: 1815–1820PubMedCrossRefGoogle Scholar
  41. 41.
    Murasugi M, Onuki T, Ikeda T, Kanzaki M, Nitta S (2001) The role of video-assisted thoracoscopic surgery in the diagnosis of the small peripheral pulmonary nodule. Surg Endosc 15: 734–736PubMedCrossRefGoogle Scholar
  42. 42.
    Nomori H, Horio H (1996) Endofinger for tactile localization of pulmonary nodules during thoracoscopic resection. Thorac Cardiovasc Surg 44: 50–53PubMedCrossRefGoogle Scholar
  43. 43.
    Nomori H, Horio H (1996) Colored collagen is a long-lasting point marker for small pulmonary nodules in thoracoscopic operations. Ann Thorac Surg 61: 1070–1073PubMedCrossRefGoogle Scholar
  44. 44.
    Nomori H, Horio H, Naruke T, Orikasa H, Yamazaki K, Suemasu K (2002) Use of technetium-99m tin colloid for sentinel lymph node identification in non-small cell lung cancer. J Thorac Cardiovasc Surg 124: 486–492PubMedCrossRefGoogle Scholar
  45. 45.
    Nomori H, Horio H, Naruke T, Suemasu K (2002) Fluoroscopy-assisted thoracoscopic resection of lung nodules marked with lipiodol. Ann Thorac Surg 74: 170–173PubMedCrossRefGoogle Scholar
  46. 46.
    Ohi S, Itoh Y, Neyatani H, Suzuki K, Kazui T (2004) Air embolism following computed tomography-guided lung needle marking; report of a case. Kyobu Geka 57: 421–423PubMedGoogle Scholar
  47. 47.
    Ohtsuka T, Furuse A, Kohno T, Nakajima J, Yagyu K, Omata S (1995) Application of a new tactile sensor to thoracoscopic surgery: experimental and clinical study. Ann Thorac Surg 60: 610–613PubMedCrossRefGoogle Scholar
  48. 48.
    Ohtsuka T, Kohno T, Nakajima J, Yagyu K, Furuse A (1997) New tactile sensor techniques for localization of pulmonary nodules. Int Surg 82: 12–14PubMedGoogle Scholar
  49. 49.
    Okumura T, Kondo H, Suzuki K, Asamura H, Kobayashi T, Kaneko M, Tsuchiya R (2001) Fluoroscopy-assisted thoracoscopic surgery after computed tomography-guided bronchoscopic barium marking. Ann Thorac Surg 71: 439–442PubMedCrossRefGoogle Scholar
  50. 50.
    Ost D, Fein A (2004) Management strategies for the solitary pulmonary nodule. Curr Opin Pulm Med 10: 272–278PubMedCrossRefGoogle Scholar
  51. 51.
    Ost D, Fein AM, Feinsilver SH (2003) Clinical practice. The solitary pulmonary nodule. N Engl J Med 348: 2535–2542PubMedCrossRefGoogle Scholar
  52. 52.
    Paci M, Annessi V, Giovanardi F, Ferrari G, De Franco S, Casali C, Sgarbi G (2002) Preoperative localization of indeterminate pulmonary nodules before videothoracoscopic resection. Surg Endosc 16: 509–511PubMedCrossRefGoogle Scholar
  53. 53.
    Piolanti M, Coppola F, Papa S, Pilotti V, Mattioli S, Gavelli G (2003) Ultrasonographic localization of occult pulmonary nodules during video-assisted thoracic surgery. Eur Radiol 13: 1358–1364CrossRefGoogle Scholar
  54. 54.
    Powell TI, Jangra D, Clifton JC, Lara-Guerra H, Church N, English J, Evans K, Yee J, Coxson H, Mayo JR, et al. (2004) Peripheral lung nodules: fluoroscopically guided video-assisted thoracoscopic resection after computed tomography-guided localization using platinum microcoils. Ann Surg 240: 481–488PubMedGoogle Scholar
  55. 55.
    Saito H, Minamiya Y, Matsuzaki I, Tozawa K, Taguchi K, Nakagawa T, Hashimoto M, Hirano Y, Ogawa J (2002) Indication for preoperative localization of small peripheral pulmonary nodules in thoracoscopic surgery. J Thorac Cardiovasc Surg 124: 1198–2202PubMedCrossRefGoogle Scholar
  56. 56.
    Santambrogio L, Nosotti M, Bellaviti N, Pavoni G, Radice F, Caputo V (1997) CT-guided fine-needle aspiration cytology of solitary pulmonary nodules: a prospective, randomized study of immediate cytologic evaluation. Chest 112: 423–425PubMedGoogle Scholar
  57. 57.
    Santambrogio R, Montorsi M, Bianchi P, Mantovani A, Ghelma F, Mezzetti M (1999) Intraoperative ultrasound during thoracoscopic procedures for solitary pulmonary nodules. Ann Thorac Surg 68: 218–222PubMedCrossRefGoogle Scholar
  58. 58.
    Sartoris F, Cittadini G, Saitta S, Ratto GB, Scarsi MP, Garlaschi G, Derchi LE (1996) CT-guided needle localization of lung nodules for thoracoscopic resection. Eur Radiol 6: 420–424PubMedCrossRefGoogle Scholar
  59. 59.
    Schwarz CD, Lenglinger F, Eckmayr J, Schauer N, Hartl P, Mayer KH (1994) VATS (video-assisted thoracic surgery) of undefined pulmonary nodules. Preoperative evaluation of videoendoscopic resectability. Chest 106: 1570–1574PubMedGoogle Scholar
  60. 60.
    Schwarz RE, Posner MC, Plunkett MB, Ferson PF, Keenan RJ, Landreneau RJ (1995) Needle-localized thoracoscopic resection of indeterminate pulmonary nodules: impact on management of patients with malignant disease. Ann Surg Oncol 2: 49–55PubMedCrossRefGoogle Scholar
  61. 61.
    Shah RM, Spirn PW, Salazar AM, Steiner RM, Cohn HE, Solit RW, Wechsler RJ, Erdman S (1993) Localization of peripheral pulmonary nodules for thoracoscopic excision: value of CT-guided wire placement. Am J Roentgenol 161: 279–283Google Scholar
  62. 62.
    Shennib H, Bret P (1993) Intraoperative transthoracic ultrasonographic localization of occult lung lesions. Ann Thorac Surg 55: 767–769PubMedCrossRefGoogle Scholar
  63. 63.
    Shepard JA, Mathisen DJ, Muse VV, Bhalla M, McLoud TC (1994) Needle localization of peripheral lung nodules for video-assisted thoracoscopic surgery. Chest 105: 1559–15631PubMedGoogle Scholar
  64. 64.
    Sortini A, Benea G, Santini S, Benetti S, Navarra G, Occhionorelli S, Sartori A (1995) Video-assisted atypical resection of peripheral lung nodules localized using CT-guided wires. First clinical experiences. Chir Ital 47: 27–29PubMedGoogle Scholar
  65. 65.
    Sortini A, Carcoforo P, Ascanelli S, Sortini D, Pozza E (2001) Significance of a single pulmonary nodule in patients with previous history of malignancy. Eur J Cardiothorac Surg 20: 1101–1105PubMedCrossRefGoogle Scholar
  66. 66.
    Sortini A, Carrella G, Sortini D, Pozza E (2002) Single pulmonary nodules: localization with intrathoracoscopic ultrasound. A prospective study. Eur J Cardiothorac Surg 22: 440–442PubMedCrossRefGoogle Scholar
  67. 67.
    Sortini A, Sortini D, Pozza E, Carrella G (2003) Intrathorascopic US: usefulness in localization of solitary pulmonary nodules. Radiology 228: 291PubMedGoogle Scholar
  68. 68.
    Sortini D, Feo CV, Carcoforo P, Carrella G, Pozza E, Liboni A, Sortini A (2005) Thoracoscopic localization techniques for patients with solitary pulmonary nodule and history of malignancy. A prospective study. Ann Thorac Surg 79: 258–262PubMedCrossRefGoogle Scholar
  69. 69.
    Sortini D, Feo CV, Carrella G, Bergossi L, Soliani G, Carcoforo P, Pozza E, Sortini A (2003) Thoracoscopic localization techniques for patients with single pulmonary nodule and positive oncological anamnesis. A prospective study. J Laparoendosc Adv Surg Tech 13: 371–375CrossRefGoogle Scholar
  70. 70.
    Sugi K, Kaneda Y, Hirasawa K, Kunitani N (2003) Radioisotope marking under CT guidance and localization using a handheld gamma probe for small or indistinct pulmonary lesions. Chest 124: 155–158PubMedCrossRefGoogle Scholar
  71. 71.
    Suzuki K, Nagai K, Yoshida J, Ohmatsu H, Takahashi K, Nishimura M, Nishiwaki Y (1999) Video-assisted thoracoscopic surgery for small indeterminate pulmonary nodules: indications for preoperative marking. Chest 115: 563–568PubMedCrossRefGoogle Scholar
  72. 72.
    Swanson SJ, Jaklitsch MT, Mentzer SJ, Bueno R, Lukanich JM, Sugarbaker DJ (1999) Management of the solitary pulmonary nodule: role of thoracoscopy in diagnosis and therapy. Chest 116: 523S–524SPubMedCrossRefGoogle Scholar
  73. 73.
    Tang AW, Moss HA, Robertson RJ (2003) The solitary pulmonary nodule. Eur J Radiol 45: 69–77PubMedCrossRefGoogle Scholar
  74. 74.
    Thaete FL, Peterson MS, Plunkett MB, Ferson PF, Keenan RJ, Landreneau RJ (1999) Computed tomography-guided wire localization of pulmonary lesions before thoracoscopic resection: results in 101 cases. J Thorac Imaging 14: 90–98PubMedGoogle Scholar
  75. 75.
    Torre M, Ferraroli GM, Vanzulli A, Fieschi S (2004) A new safe and stable spiral wire needle for thoracoscopic resection of lung nodules. Chest 125: 2289–2293PubMedCrossRefGoogle Scholar
  76. 76.
    Tsuchida M, Yamato Y, Aoki T, Watanabe T, Koizumi N, Emura I, Hayashi J (1999) CT-guided agar marking for localization of nonpalpable peripheral pulmonary lesions. Chest 116: 139–143PubMedCrossRefGoogle Scholar
  77. 77.
    Vandoni RE, Cuttat JF, Wicky S, Suter M (1998) CT-guided methylene-blue labelling before thoracoscopic resection of pulmonary nodules. Eur J Cardiothorac Surg 14: 265–270PubMedCrossRefGoogle Scholar
  78. 78.
    Westcott JL, Rao N, Colley DP (1997) Transthoracic needle biopsy of small pulmonary nodules. Radiology 202: 97–103PubMedGoogle Scholar
  79. 79.
    Wicky S, Dusmet M, Doenz F, Ris HB, Schnyder P, Portier F (2002) Computed tomography-guided localization of small lung nodules before video-assisted resection: experience with an efficient hook-wire system. J Thorac Cardiovasc Surg 124: 401–403PubMedCrossRefGoogle Scholar
  80. 80.
    Wicky S, Mayor B, Cuttat JF, Schnyder P (1994) CT-guided localization of pulmonary nodules with methylene blue injections for thoracoscopic resections. Chest 106: 1326–1328PubMedGoogle Scholar
  81. 81.
    Wicky S, Mayor B, Schnyder P (1997) Methylene blue localizations of pulmonary nodules under CT-guidance: a new procedure used before thoracoscopic resections. Int Surg 82: 15–17PubMedGoogle Scholar
  82. 82.
    Yamamoto M, Takeo F, Meguro F, Ishikawa T (2003) Sonographic evaluation for peripheral pulmonary nodules during video-assisted thoracoscopic surgery. Surg Endosc 17: 825–827PubMedCrossRefGoogle Scholar
  83. 83.
    Yoshida J, Nagai K, Nishimura M, Takahashi K (1999) Computed tomography-fluoroscopy guided injection of cyanoacrylate to mark a pulmonary nodule for thoracoscopic resection. Jpn J Thorac Cardiovasc Surg 47: 210–213PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • D. Sortini
    • 1
  • C. Feo
    • 1
  • K. Maravegias
    • 1
  • P. Carcoforo
    • 1
  • E. Pozza
    • 1
  • A. Liboni
    • 1
  • A. Sortini
    • 1
  1. 1.Department of Surgical, Anaesthesiological, and Radiological SciencesUniversity of FerraraFerraraItaly

Personalised recommendations