Diagnostic and Interventional Radiology
Chest Imaging - Original Article

Percutaneous transthoracic localization of pulmonary nodules under C-arm cone-beam CT virtual navigation guidance

1.

Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.

2.

Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea; Cancer Research Institute Seoul National University, Seoul, Korea

3.

Department of Radiology, Duke University Medical Center, Durham, NC, USA

4.

Department of Thoracic Surgery, Seoul National University College of Medicine, Seoul, Korea

Diagn Interv Radiol 2016; 22: 224-230
DOI: 10.5152/dir.2015.15297
Read: 456 Downloads: 127 Published: 03 September 2019

Abstract

PURPOSE

We aimed to describe our initial experience with percutaneous transthoracic localization (PTL) of pulmonary nodules using a C-arm cone-beam CT (CBCT) virtual navigation guidance system.

 

METHODS

From February 2013 to March 2014, 79 consecutive patients (mean age, 61±10 years) with 81 solid or ground-glass nodules (mean size, 12.36±7.21 mm; range, 4.8–25 mm) underwent PTLs prior to video-assisted thoracoscopic surgery (VATS) excision under CBCT virtual navigation guidance using lipiodol (mean volume, 0.18±0.04 mL). Their procedural details, radiation dose, and complication rates were described.

 

RESULTS

All 81 target nodules were successfully localized within 10 mm (mean distance, 2.54±3.24 mm) from the lipiodol markings. Mean number of CT acquisitions was 3.2±0.7, total procedure time was 14.6±5.14 min, and estimated radiation exposure during the localization was 5.21±2.51 mSv. Postprocedural complications occurred in 14 cases (17.3%); complications were minimal pneumothorax (n=10, 12.3%), parenchymal hemorrhage (n=3, 3.7%), and a small amount of hemoptysis (n=1, 1.2%). All target nodules were completely resected; pathologic diagnosis included invasive adenocarcinoma (n=53), adenocarcinoma-in-situ (n=10), atypical adenomatous hyperplasia (n=4), metastasis (n=7), and benign lesions (n=7).

 

CONCLUSION

PTL procedures can be performed safely and accurately under the guidance of a CBCT virtual navigation system.

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