CT-Guided Percutaneous Radiotracer Localization and Resection of Indistinct/Small Pulmonary Lesions

BACKGROUND: Detection of small pulmonary lesions has increased and often they are difficult to localize and resect. We present our mature experience with preoperative computer-tomography (CT)-guided radiotracer localization followed by resection of these lesions. METHODS: Patients with pulmonary nodule smaller than 1 cm and/or deep below the visceral pleura underwent CT-guided injection of radiotracer technetium macroaggregates (99mTc-MAA) in/close to the lesion. A gamma probe was used to localize the marked area that was resected and in case of primary lung cancer, a lobectomy with nodal dissection was performed. RESULTS: Between November 2007 and December 2017, 262 patients (196 men; median age 63 years) underwent preoperative radiotracer injection with a successful marking in all patients. Complications included 35 (13.4%) asymptomatic pneumothoraces, 36 (13.7%) parenchymal hemorrhage suffusions, and 2 (0.7%) mild allergic reactions to contrast medium. In all cases, except for 3, the gamma probe revealed the pulmonary lesion. Mean distance from the pleura was 10 mm (range, 0-40 mm). Pulmonary resection was performed by thoracoscopy in 212 (80.9%) cases, intentional thoracotomy in 42 (16.0%), converted thoracoscopy in 8 (3.1%). Mean pathological nodule size was 9.3 mm (range, 2.5-39 mm). 166 (63.4%) nodules were nonsolid, 64 (24.4%) were partially solid, and 32 (12.2%) had a solid morphology. Histology showed 16 (6.1%) benign and 246 (93.9%) malignant lesions (218 primary lung cancers). CONCLUSIONS: Preoperative radiotracer localization of small/indistinct pulmonary lesions is simple and feasible with a high rate of success. It may be an effective and attractive alternative in managing lung lesions.