Non-palpable Pulmonary Nodules and Uniportal-VATS: Radio-guided Localization (ROLL) Experience of a Lung Multidisciplinary Team

Abstract

Background/aim: Surgical resection with a minimally invasive approach is the standard for diagnosing and treating solitary pulmonary nodules. A computed tomography (CT)-guided technetium^99m-macroaggregated albumin (^99mTc-MAA) injection-based procedure has been employed for small and non-palpable lung nodule radio-guided preoperative localization (ROLL). This procedure is usually followed by video-assisted thoracoscopic surgery (VATS). This study retrospectively evaluated the feasibility, clinicopathologic outcomes, and complications of this localization radio-guided procedure followed by uniportal VATS.

Patients and methods: This retrospective study included 63 patients with suspicious lung nodules who underwent ^99mTc-MAA CT-guided localization before uniportal VATS. The analysis examined the imaging and procedure characteristics, procedural risks, successful intra-operative localization, wedge resection, conversion from VATS to open thoracotomy, the reason, and histological diagnosis for each nodule. Also, it was evaluated how nodule and procedure features affected successful intra-operative localization.

Results: All patients were diagnosed using a CT scan, and 90.4% had a PET scan at basal staging. A round-glass morphology was present in 9.6% of cases, whereas most had a solid appearance. The mean nodule size was 9.78 mm (maximal tumoral diameter) with a 1-23 mm range. The mean distance from the pleural surface was 15.6 mm (range=1-117 mm). The detection rate of the ^99mTc-MAA CT-guided localization procedure was 100%. Surgical procedures were uniportal VATS and transpleural thoracoscopy in 52 (82.5%) and 11 (17.5%) patients, respectively. The intraoperative localization rate was 98.4%. Pneumothorax represented the most frequent complication (6.3%), with one case clinically significant and three only with minimal radiological evidence. Pathology confirmed radical excision in all cases.

Conclusion: Lung nodule localization with CT-guided ^99mTc-MAA followed by uniportal VATS is feasible with a high success rate and low complication rate.

Keywords: (99m)Tc-macroaggregated albumin; VATS; lung nodule; radio-guided surgery; uniportal video-assisted thoracoscopic surgery.