Preoperative computed tomography-guided marking of pulmonary peripheral tumorous lesions

Abstract

A series of 25 cases of thoracoscopic resection after CT-guided marking, using a hookwire with a string, for pulmonary peripheral tumorous lesions, were subjected to a study on the usefulness and safety of preoperative marking. Mean tumor size was 10.4±4.8mm in maximum diameter. Fourteen cases were smaller than 10 mm. Mean depth from visceral pleura was 5.5±6.7mm. Preoperative marking was useful for localization of lesions in 14 cases of lesions without pleural change. Placement of individual hookwires took 18.6±5.4minutes. Excisional biopsies required 27.8±17.6 minutes. Except for one case with intensive pleural adhesion, thoracoscopic resections were successfully performed. In all cases, definitive diagnosis was obtained intraoperatively by frozen section, which coincided with that provided by permanent pathology. We experienced complications in ten cases: pneumothorax in nine, and transient ischemic attack in one. The preoperative CT-guided marking using a hookwire with a string, which can be done conveniently and promptly, is useful in video-assisted thoracoscopic wedge resection of the lung. Complications such as pneumothorax should be kept in mind, and observations and biopsies under thoracoscopy after marking should be done as soon as possible.