Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Cancer
Published in: BMC Cancer 1/2014

Open Access 01-12-2014 | Research article

A new technique combining virtual simulation and methylene blue staining for the localization of small peripheral pulmonary lesions

Authors: Yang Shentu, Liang Zhang, Hengle Gu, Feng Mao, Minghui Cai, Zhengping Ding, Zhiqiang Wang

Published in: BMC Cancer | Issue 1/2014

Login to get access

Abstract

Background

Quickly and accurately localizing small peripheral pulmonary lesions can avoid prolonged operative time and unplanned open thoracotomy. In this study, we aimed to introduce and evaluate a new technique combining virtual simulation and methylene blue staining for the localization of small peripheral pulmonary lesions.

Methods

Seventy four (74) patients with 80 peripheral pulmonary lesions <20 mm in size on computer tomography (CT) were virtually punctured using a radiotherapy planning simulator on the day before operation. Under general anaesthesia, methylene blue dye was injected to the virtually identified point according to the surface point, angle and depth previously determined by the simulator. The wedge resection of the marked lesion was performed under video-assisted thoracoscopic surgery (VATS) and the specimens were sent for immediate pathologic examination. According to pathology results, appropriate surgical procedures were decided and undertaken.

Results

The average lesion size was 10.4±3.5 mm (range: 4-17 mm) and the average distance to the pleural surface was 9.4±4.9 mm. Our preoperative localization procedure was successful in 75 of 80 (94%) lesions. Histological examination showed 28 benign lesions and 52 lung cancers. The shortest distance between the edges of the stain and lesion was 5.1±3.1 mm. Localization time was 17.4±2.3 min. All patients with malignant lesions subsequently underwent lobectomy and systematic lymph node dissection. No complications were observed in all participants.

Conclusions

The novel technique combining the preoperative virtual simulation and methylene blue staining techniques has a high success rate for localizing small peripheral pulmonary lesions, particularly for those tiny lesions which are difficult to visualise and palpate during VATS.
Appendix
Available only for authorised users
Literature
1.
Wahidi MM, Govert JA, Goudar RK, Gould MK, McCrory DC: Evidence for the treatment of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007, 132 (3 Suppl): 94S-107S.CrossRefPubMed
2.
Mayo JR, Clifton JC, Powell TI, English JC, Evans KG, Yee J, McWilliams AM, Lam SC, Finley RJ: Lung nodules: CT-guided placement of microcoils to direct video-assisted thoracoscopic surgical resection. Radiology. 2009, 250 (2): 576-585. 10.1148/radiol.2502080442.CrossRefPubMed
3.
Powell TI, Jangra D, Clifton JC, Lara-Guerra H, Church N, English J, Evans K, Yee J, Coxson H, Mayo JR, et al: Peripheral lung nodules: fluoroscopically guided video-assisted thoracoscopic resection after computed tomography-guided localization using platinum microcoils. Ann Surg. 2004, 240 (3): 481-488. 10.1097/01.sla.0000137132.01881.57. discussion 488-489CrossRefPubMedPubMedCentral
4.
Kohi MP, Naeger DM, Kukreja J, Fidelman N, Laberge JM, Gordon RL, Kerlan RK: Preoperative CT-guided percutaneous wire localization of ground glass pulmonary nodules with a modified Kopans wire. J Thorac Dis. 2013, 5 (2): E31-34.PubMedPubMedCentral
5.
Saito H, Minamiya Y, Matsuzaki I, Tozawa K, Taguchi K, Nakagawa T, Hashimoto M, Hirano Y, Ogawa J: Indication for preoperative localization of small peripheral pulmonary nodules in thoracoscopic surgery. J Thorac Cardiovasc Surg. 2002, 124 (6): 1198-1202. 10.1067/mtc.2002.127331.CrossRefPubMed
6.
Suzuki K, Nagai K, Yoshida J, Ohmatsu H, Takahashi K, Nishimura M, Nishiwaki Y: Video-assisted thoracoscopic surgery for small indeterminate pulmonary nodules: indications for preoperative marking. Chest. 1999, 115 (2): 563-568. 10.1378/chest.115.2.563.CrossRefPubMed
7.
Endo M, Kotani Y, Satouchi M, Takada Y, Sakamoto T, Tsubota N, Furukawa H: CT fluoroscopy-guided bronchoscopic dye marking for resection of small peripheral pulmonary nodules. Chest. 2004, 125 (5): 1747-1752. 10.1378/chest.125.5.1747.CrossRefPubMed
8.
Lenglinger FX, Schwarz CD, Artmann W: Localization of pulmonary nodules before thoracoscopic surgery: value of percutaneous staining with methylene blue. AJR Am J Roentgenol. 1994, 163 (2): 297-300.CrossRefPubMed
9.
Zhang L, Shen-Tu Y: The advance and new methods explore of pulmonary tiny lesions preoperative localization. Zhongguo Fei Ai Za Zhi. 2012, 15 (6): 381-385.PubMed
10.
Aird EG, Conway J: CT simulation for radiotherapy treatment planning. Br J Radiol. 2002, 75 (900): 937-949.CrossRefPubMed
11.
Hanna GG, Van SDKJR, Carson KJ, O’Sullivan JM, Hounsell AR, Senan S: Conventional 3D staging PET/CT in CT simulation for lung cancer: impact of rigid and deformable target volume alignments for radiotherapy treatment planning. Br J Radiol. 2011, 84 (1006): 919-929. 10.1259/bjr/29163167.CrossRefPubMedPubMedCentral
12.
StataCorp: Stata Statistical Software: Release 12. 2011, College Station, Texas: StataCorp LP
13.
Diederich S: Lung cancer screening: rationale and background. Cancer Imaging. 2011, 11 Spec No A: S75-78.CrossRefPubMed
14.
Diederich S, Thomas M, Semik M, Lenzen H, Roos N, Weber A, Heindel W, Wormanns D: Screening for early lung cancer with low-dose spiral computed tomography: results of annual follow-up examinations in asymptomatic smokers. Eur Radiol. 2004, 14 (4): 691-702. 10.1007/s00330-003-2200-5.CrossRefPubMed
15.
Plunkett MB, Peterson MS, Landreneau RJ, Ferson PF, Posner MC: Peripheral pulmonary nodules: preoperative percutaneous needle localization with CT guidance. Radiology. 1992, 185 (1): 274-276.CrossRefPubMed
16.
Sawhney R, McCowin MJ, Wall SD, Block MI: Fluoroscopically guided placement of the Kopans hookwire for lung nodule localization prior to thoracoscopic wedge resection. J Vasc Interv Radiol. 1999, 10 (8): 1133-1134. 10.1016/S1051-0443(99)70207-1.CrossRefPubMed
17.
Soleto MJ, Olivera MJ, Pun YW, Moreno R, Nieto S, Caballero P: Hookwire localization of pulmonary nodules for video-thorascopic surgical resection. Arch Bronconeumol. 2002, 38 (9): 406-409. 10.1016/S0300-2896(02)75252-6.CrossRefPubMed
18.
Zhou JH, Li WT, Chen HQ, Peng WJ, Xiang JQ, Zhang YW, Wang SP, Yang F, Zhou X, Luo XY: CT-guided hookwire localization of small solitary pulmonary nodules in video-assisted thoracoscopic surgery. Zhonghua Zhong Liu Za Zhi. 2009, 31 (7): 546-549.PubMed
19.
Wang YZ, Boudreaux JP, Dowling A, Woltering EA: Percutaneous localisation of pulmonary nodules prior to video-assisted thoracoscopic surgery using methylene blue and TC-99. Eur J Cardiothorac Surg. 2010, 37 (1): 237-238. 10.1016/j.ejcts.2009.07.022.CrossRefPubMed
20.
Wicky S, Mayor B, Schnyder P: Methylene blue localizations of pulmonary nodules under CT-guidance: a new procedure used before thoracoscopic resections. Int Surg. 1997, 82 (1): 15-17.PubMed
21.
Nomori H, Horio H: Colored collagen is a long-lasting point marker for small pulmonary nodules in thoracoscopic operations. Ann Thorac Surg. 1996, 61 (4): 1070-1073. 10.1016/0003-4975(96)00024-0.CrossRefPubMed
22.
Tsuchida M, Yamato Y, Aoki T, Watanabe T, Koizumi N, Emura I, Hayashi J: CT-guided agar marking for localization of nonpalpable peripheral pulmonary lesions. Chest. 1999, 116 (1): 139-143. 10.1378/chest.116.1.139.CrossRefPubMed
23.
Shennib H, Bret P: Intraoperative transthoracic ultrasonographic localization of occult lung lesions. Ann Thorac Surg. 1993, 55 (3): 767-769. 10.1016/0003-4975(93)90293-Q.CrossRefPubMed
24.
Piolanti M, Coppola F, Papa S, Pilotti V, Mattioli S, Gavelli G: Ultrasonographic localization of occult pulmonary nodules during video-assisted thoracic surgery. Eur Radiol. 2003, 13 (10): 2358-2364. 10.1007/s00330-003-1916-6.CrossRefPubMed
25.
Mattioli S, D’Ovidio F, Daddi N, Ferruzzi L, Pilotti V, Ruffato A, Bolzani R, Gavelli G: Transthoracic endosonography for the intraoperative localization of lung nodules. Ann Thorac Surg. 2005, 79 (2): 443-449. 10.1016/j.athoracsur.2004.07.087. discussion 443-449CrossRefPubMed
26.
Chen W, Chen L, Qiang G, Chen Z, Jing J, Xiong S: Using an image-guided navigation system for localization of small pulmonary nodules before thoracoscopic surgery: a feasibility study. Surg Endosc. 2007, 21 (10): 1883-1886. 10.1007/s00464-007-9198-8.CrossRefPubMed
Metadata
Title
A new technique combining virtual simulation and methylene blue staining for the localization of small peripheral pulmonary lesions
Authors
Yang Shentu
Liang Zhang
Hengle Gu
Feng Mao
Minghui Cai
Zhengping Ding
Zhiqiang Wang
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2014
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/1471-2407-14-79

Other articles of this Issue 1/2014

BMC Cancer 1/2014 Go to the issue

Research article

Population-based incidence trends of oropharyngeal and oral cavity cancers by sex among the poorest and underprivileged populations

Research article

Cost-effectiveness of family history-based colorectal cancer screening in Australia

Research article

Quantitative analysis of castration resistant prostate cancer progression through phosphoproteome signaling

Research article

FHL1C induces apoptosis in notch1-dependent T-ALL cells through an interaction with RBP-J

Study protocol

The CAIRO4 study: the role of surgery of the primary tumour with few or absent symptoms in patients with synchronous unresectable metastases of colorectal cancer – a randomized phase III study of the Dutch Colorectal Cancer Group (DCCG)

Research article

Activation of AMP-activated protein kinase attenuates hepatocellular carcinoma cell adhesion stimulated by adipokine resistin
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits