Interventional non-vascular, Thorax, Lung, CT, Percutaneous, Diagnostic procedure, Surgery, Multidisciplinary cancer care
M. R. Calero Garcia1, G. GARCIA GALARRAGA1, N. Pérez Peláez2, M. De la Puente Herraiz1, A. B. Enguita Valls1, J. C. Meneses Pardo1; 1Madrid/ES, 2Madrid, Madrid/ES
Lung cancer is the most common cause of cancer death in developed countries,
and survival rate is closely related to the stage at diagnosis.
Early detection of malignant nodules can be potentially curative.
Lungs are also a common site for metastases from other primary malignancies.
Small subcentimeter nodules are frecuent finding in cross sectional images (mainly CT and PET-CT scans) carried out for multiple medical conditions.
caracterization of this nodules with noninvasive imaging techniques is often difficult and tissue confirmation can be needed in order to offer the appropiate treatment.
It is important to avoid false positive diagnosis of cancer leading to excesive volume of resected parenchyma, and false negative diagnosis leaving a potentially treatable disease untreated.
CT-guided transthoracic needle biopsy and transbronchial biopsy of small lung nodules often leads to sampling errors and excisional biopsy using VATS is often performed.
It is a minimally invasive method,
that can serve for treatment in addition to diagnosis,
and offers a less traumatic access to the thoracic cavity and less postoperative morbidity than open thoracic surgery.
intraoperative localization of suspicious intrapulmonary lesions can be difficult and time-consuming. The main limitation to VATS is that manual intra-operative palpation of the parenchyma is not feasible,
and small deeply located or ground-glass opacity (GGO) lesions may be missed.
Several methods for percutaneous preoperative localization of the lesion have been describe to diminish this problem: methylene blue staining,
lipiodol localization and hook-wire localization under CT guidance.
CT-guided insertion of a hook-wire into or nearby the nodule helps to find the lesion and reduce the operative time,
with a reported success rate of preoperative placement of 84-99,6%.