Simultaneous Patent Blue Dye Injections Aid in the Preoperative CT-Guided Localization of Multiple Pulmonary Nodules

Abstract

Background and Objectives: Clinically, a major challenge of multiple nodule localization is puncture-related pneumothorax, which may hamper the successful localization. This study aims to investigate and compare the efficacy and safety of the simultaneous and sequential patent blue dye (PBD) injections for identifying multiple pulmonary nodules during preoperative CT-guided localization. Materials and Methods: Sixty-one consecutive patients with multiple pulmonary nodules who underwent preoperative CT-guided localization with PBD injections between January 2020 and December 2020 were retrospectively enrolled. Of these patients, 31 patients with 64 nodules who underwent simultaneous injections were designated as the simultaneous group; the remaining 30 patients with 63 nodules who underwent sequential punctures were designated as the sequential group. The clinical and radiological features, technical information, pathological results, and procedure-related variables and complications of the two groups were reviewed and analyzed. Results: The localization success rate of the simultaneous group was higher than that of the sequential group (100% [64/64] vs. 93.7% [59/63], p = 0.041). The incidences of pneumothorax (32.3 vs. 33.3%, p = 0.929) and pulmonary hemorrhage (6.3 vs. 3.0%, p = 1) were not significantly different between the two groups, and all cases were minor, which did not require further intervention. Additionally, a significantly lower radiation dose (2.7 vs. 3.5 mSv, p = 0.001) and a shorter procedure time (20.95 vs. 25.28 min, p = 0.001) were observed in the simultaneous group than in the sequential group. Conclusions: Compared with the sequential method, simultaneous PBD injections may improve the localization success rate with a shorter procedure time and less radiation exposure if the patient with multiple pulmonary nodules can be approached in a single position. Further prospective studies are needed to validate these results.

Keywords: adenocarcinoma; patent blue dye; pulmonary nodule; simultaneous localization; video-assisted thoracoscopic surgery.

Figure 1

(A,B) Localization via simultaneous puncture with patent blue dye (PBD) injection of two subsolid nodules (arrows) was performed in a 58-year-old female in the lateral decubitus position; (C,D) The stained areas on the visceral pleura were obviously identified during video-assisted thoracoscopic surgery (VATS). These two nodules were proved to be invasive adenocarcinomas.

Figure 2

Simultaneous puncture with PBD injection of three nodules in a 70-year-old male. (A–C) Axial CT scan showed 22-gauge Chiba needles simultaneously puncturing two subsolid nodules (arrow) in the RUL and one subsolid nodule (arrow) in the RML during one breath-hold; (D) VATS identified PBD stains (★) of the three nodules on the visceral pleura of the RUL and RML. All pathological results indicated invasive adenocarcinoma. Abbreviations: RUL, right upper lobe; RML, right middle lobe.