Computed Tomography-guided Localization with a Hook-wire Followed by Video-assistedThoracic Surgery for Small Intrapulmonary and Ground Glass Opacity Lesions

Kang, Pil Je; Kim, Yong Hee; Park, Seung Il; Kim, Dong Kwan; Song, Jae Woo; Do, Kyoung Hyun

Abstract

BACKGROUND: Making the histologic diagnosis of small pulmonary nodules and ground glass opacity (GGO) lesions is difficult. CT-guided percutaneous needle biopsies often fail to provide enough specimen for making the diagnosis. Video-assisted thoracoscopic surgery (VATS) can be inefficient for treating non-palpable lesions. Preoperative localization of small intrapulmonary lesions provides a more obvious target to facilitate performing intraoperative resection. We evaluated the efficacy of CT-guided localization with using a hook wire and this was followed by VATS for making the histologic diagnosis of small intrapulmonary nodules and GGO lesions. MATERIAL AND METHOD: Eighteen patients (13 males) were included in this study from August 2005 to March 2008. 18 intrapulmonary lesions underwent preoperative localization by using a CT-guided a hook wire system prior to performing VATS resection for intrapulmonary lesions and GGO lesions. The clinical data such as the accuracy of localization, the rate of conversion-to-thoracotomy, the operation time, the postoperative complications and the histology of the pulmonary lesion were retrospectively collected. RESULT: Eighteen VATS resections were performed in 18 patients. Preoperative CT-guided localization with a hook-wire was successful in all the patients. Dislodgement of a hook wire was observed in one case. There was no conversion to thoracotomy. The median diameter of lesions was 8 mm (range: 3~15 mm). The median depth of the lesions from the pleural surfaces was 5.5 mm (range: 1~30 mm). The median interval between preoperative CT-guided localization with a hook-wire and VATS was 34.5 min (range: 10~ 226 min). The median operative time was 43.5 min (range: 26~83 min). In two patients, clinically insignificant pneumothorax developed after CT-guided localization with a hook-wire and there were no other complications. Histological examinations confirmed 8 primary lung cancers, 3 cases of metastases, 3 cases of inflammation, 2 intrapulmonary lymph nodes and 2 other benign lesions.
CONCLUSION
CT-guided localization with a hook-wire followed by VATS for treating small intrapulmonary nodules and GGO lesions provided a low conversion thoracotomy rate, a short operation time and few localization-related or postoperative complications. This procedure was efficient to confirm intrapulmonary lesions and GGO lesions.