A new technique combining virtual simulation and methylene blue staining for the localization of small peripheral pulmonary lesions

BMC Cancer

Zhiqiang Wang¹  Zhengping Ding³  Minghui Cai³  Feng Mao³  Hengle Gu³  Liang Zhang²  Yang Shentu³ 

[1]School of Medicine, University of Queensland, QLD 4029 Queensland, Australia

[2]Department of Thoracic Oncology Medicine, Jilin Tumor Hospital, Changchun 130012, Jilin Province, China

[3]Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China

关键词: Methylene blue;    Simulation;    Localization;    Thoracoscopy;    Pulmonary lesions;    Lung cancer;   

Others  :  859078
DOI  :  10.1186/1471-2407-14-79

 received in 2013-12-08, accepted in 2014-02-06,  发布年份 2014

【 摘 要 】

Background

Quickly and accurately localizing small peripheral pulmonary lesions can avoid prolonged operative time and unplanned open thoracotomy. In this study, we aimed to introduce and evaluate a new technique combining virtual simulation and methylene blue staining for the localization of small peripheral pulmonary lesions.

Methods

Seventy four (74) patients with 80 peripheral pulmonary lesions <20 mm in size on computer tomography (CT) were virtually punctured using a radiotherapy planning simulator on the day before operation. Under general anaesthesia, methylene blue dye was injected to the virtually identified point according to the surface point, angle and depth previously determined by the simulator. The wedge resection of the marked lesion was performed under video-assisted thoracoscopic surgery (VATS) and the specimens were sent for immediate pathologic examination. According to pathology results, appropriate surgical procedures were decided and undertaken.

Results

The average lesion size was 10.4±3.5 mm (range: 4-17 mm) and the average distance to the pleural surface was 9.4±4.9 mm. Our preoperative localization procedure was successful in 75 of 80 (94%) lesions. Histological examination showed 28 benign lesions and 52 lung cancers. The shortest distance between the edges of the stain and lesion was 5.1±3.1 mm. Localization time was 17.4±2.3 min. All patients with malignant lesions subsequently underwent lobectomy and systematic lymph node dissection. No complications were observed in all participants.

Conclusions

The novel technique combining the preoperative virtual simulation and methylene blue staining techniques has a high success rate for localizing small peripheral pulmonary lesions, particularly for those tiny lesions which are difficult to visualise and palpate during VATS.

【 授权许可】

   
2014 Shentu et al.; licensee BioMed Central Ltd.

【 图 表 】

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