Preoperative localization of small peripheral pulmonary nodules by percutaneous marking under computed tomography guidance

The outcome of computed tomography (CT)-guided percutaneous marking for the preoperative localization of small peripheral pulmonary nodules was analyzed retrospectively. This procedure, in which 21-gauge markers were placed near nodules under local anesthesia on the day of surgery, concerned the patients who received video-assisted thoracoscopic surgery as a primary operative technique. The study included all the 57 patients who underwent CT-guided percutaneous marking before pulmonary resection. The mean nodule size was 1.1 cm. Pneumothorax and pulmonary bleeding were observed in 28 and 17 patients, respectively. Other complications included pain (four), subcutaneous bleeding (two) and dislodgment of the marker (one). Wedge resection during thoracotomy was necessary in seven patients because of severe adhesions (four), multiple wedge resections (one), dislodgment of the marker (one) and difficulty in identifying a nodule (one). Pathological studies revealed 24 metastatic lung tumors, 19 bronchioloalveolar carcinomas (BACs), five adenocarcinomas with mixed subtypes, three granulomas, two atypical adenomatous hyperplasias and six miscellaneous others. Wedge resection for malignancy was performed in 39 patients with 41 lesions. The median follow-up period was 46 months. A positive surgical margin and recurrence at the surgical stump were observed in one case each. In conclusion, preoperative CT-guided marking was safe and effective, although marker dislodgment, positive surgical margin and recurrence at the surgical stump were observed infrequently.