Original Article
Computed tomography criteria for the use of advanced localization techniques in minimally invasive thoracoscopic lung resection Min P. Kim1,2, Duc T. Nguyen3, Edward Y. Chan1,2, Leonora M. Meisenbach1, Lisa M. Kopas4, Edward A. Graviss3, Alan B. Lumsden5, Nakul Gupta6 1
Division of Thoracic Surgery, Department of Surgery, 2Department of Surgery, Weill Cornell Medical College, 3Department of Pathology &
Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA; 4Pulmonary Critical Care & Sleep Medicine Consultants, Houston, TX, USA; 5Department of Cardiovascular Surgery, 6Department of Radiology, Houston Methodist Hospital, Houston, TX, USA Contributions: (I) Conception and design: MP Kim, EY Chan, LM Meisenbach, LM Kopas, AB Lumsden, N Gupta; (II) Administrative support: MP Kim, EY Chan, LM Kopas, EA Graviss, AB Lumsden, N Gupta; (III) Provision of study materials or patients: MP Kim, EY Chan, LM Meisenbach, LM Kopas, AB Lumsden, N Gupta; (IV) Collection and assembly of data: MP Kim, EY Chan, LM Meisenbach, LM Kopas, AB Lumsden, N Gupta; (V) Data analysis and interpretation: MP Kim, DT Nguyen, EY Chan, EA Graviss, N Gupta; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Min P. Kim, MD, FACS. Division of Thoracic Surgery, Department of Surgery, Weill Cornell Medical College, 6550 Fannin Street, Suite 1661, Houston, TX 77030, USA. Email:
[email protected].
Background: The significant improvement of patient outcomes from minimally invasive lung surgery has led to the development of advanced lung nodule localization techniques to help manage patients with small suspicious lung nodules or to help resect patients with small pulmonary metastases. However, there are no clear computed tomography (CT) criteria to guide the use of advanced localization techniques for this group of patients. Methods: We conducted a retrospective chart review of patients who had undergone initial wedge resection of single or multiple lung nodules. We collected demographics, surgical information and surgical outcomes as well as CT scan features. Multiple logistic regression was performed to determine which factors were most predictive of the need for advanced localization techniques Results: A total of 45 patients (73%) were resected by direct identification alone while 17 patients (27%) required advanced localization techniques. Of those requiring advanced localization, 11 patients had cone beam CT, 3 patients had transbronchial localization using electromagnetic navigation and 3 patients had preoperative CT guided wire localization. Patients requiring advanced localization had significantly smaller lung nodules at 0.8 cm compared to 1.4 cm (P=0.01), nodules that were further away from the pleura at 1.3 cm compared 0.1 cm (P5 mm away from the pleura that was
