A new protocol for concomitant needle aspiration biopsy and localization of solitary pulmonary nodules (Journal of Cardiothoracic Surgery)

Background: Pulmonary nodules may require thoracoscopic resection in cases where percutaneous needle aspiration (PCNA) is non-diagnostic or not technically feasible. We developed a new protocol to localize pulmonary nodules concomitantly with PCNA. We retrospectively reviewed the use of concomitant PCNA and preoperative localization under computed tomography (CT) guidance. Methods: From Jan 2006 to Dec 2013, we performed PCNA and localization concomitantly on 34 pulmonary nodules (in 33 patients) using self-made, platinum microcoils. Patients in which PCNA results were less likely to be non-diagnostic and who were anticipating thoracoscopy were eligible to participate in this study. The CT-guided PCNA biopsy and microcoil localization was performed on the day of the VATS in the CT suite. The PCNA specimen was sent to the pathologist for frozen section pathology. If diagnosis of the lesion was not confirmed by PCNA or was primary lung cancer, the patient was moved to the operating room for VATS surgery. Results: Between Jan 2006 and Dec 2013, concomitant PCNA and localization were successfully performed on 34 pulmonary nodules from 33 patients (one patient had two nodules). Of the 34 nodules, seven were diagnosed pathologically using PCNA, and 27 nodules that could not be diagnosed by PCNA were excised by thoracoscopic resection without additional procedures or time because of concomitant localization. There were no deaths or significant morbidities. Minor complications included three incidents of lung hemorrhage and five of pneumothorax (two required closed thoracostomy drainage). Of 34 nodules in which both PCNA and localization were used, thoracoscopic resections were performed on 33, lobectomies were performed concomitantly with thoracoscopic resection on 11. Intraoperative fluoroscopy was used to detect 33 of 34 nodules localized using the platinum microcoil (97.06 %) or to guide stapling during thoracoscopic resection. Conclusions: The advantages of this technique are 1) there is no need for further localization during thoracoscopy even in cases of unsuccessful PCNA, 2) it is more effective with respect to both cost and time, and 3) it provides greater patient comfort.