Preoperative radio-guided localization of lung nodules with I-125 seeds: experience with 32 patients at a single institution

• Published in: Interactive cardiovascular and thoracic surgery Vol. 34; no. 1; pp. 91 - 98
• Main Authors: Fra-Fernández, Sara, Gorospe-Sarasúa, Luis, Ajuria-Illarramendi, Odile, Serrano-Carvajal, Percy Enrique, Muñoz-Molina, Gemma María, Cabañero-Sánchez, Alberto, Rioja-Martin, Maria Eugenia, Moreno-Mata, Nicolás
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 06-01-2022
• Subjects: Humans; Iodine Radioisotopes; Lung; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - surgery; Multiple Pulmonary Nodules - diagnostic imaging; Multiple Pulmonary Nodules - surgery; Preoperative Care; Retrospective Studies; Solitary Pulmonary Nodule - diagnostic imaging; Solitary Pulmonary Nodule - surgery; Thoracic; Thoracic Surgery, Video-Assisted - methods; Subsolid nodules; Computed tomography; Pulmonary nodules; Preoperative localization; Radio-guided; Video-assisted thoracic surgery; I-125 seeds
• ISSN: 1569-9285; 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivab223

Abstract

OBJECTIVES
Videothoracoscopic visualization and/or palpation of pulmonary nodules may be difficult due to their location, small size or limited solid component. The purpose of this study is to present our experience with computed tomography (CT)-guided preoperative localization of pulmonary nodules by percutaneous marking with radio-labelled iodine-125 seeds.
METHODS
A total of 34 pulmonary nodules were marked under CT with the placement of 33 radio-labelled iodine-125 seeds in 32 consecutive patients.
RESULTS
All patients underwent biportal video-assisted thoracic surgery (VATS) and in no case was conversion to thoracotomy necessary. A total of 88.2% of the lung nodules were successfully resected. In the remaining 11.8%, migration of the seed to the pleural cavity occurred, although these nodules were still resected during VATS. Of all the patients with pneumothorax after the marking procedure, only one required chest tube placement (3.1%). No major postoperative complications were observed.
CONCLUSIONS
Preoperative marking of pulmonary nodules with I-125 seeds under CT guidance is a feasible and safe technique that allows their intraoperative identification and resection.
Video-assisted thoracic surgery (VATS) has become a very useful tool in the diagnostic and therapeutic management of lung lesions [1].