Computed Tomography Guided Percutaneous Injection of a Mixture of Lipiodol and Methylene Blue in Rabbit Lungs: Evaluation of Localization Ability for Video-Assisted Thoracoscopic Surgery

다국어 초록 (Multilingual Abstract)

Preoperative localization is necessary prior to video assisted thoracoscopic surgery for the detection of small or deeply located lung nodules. We compared the localization ability of a mixture of lipiodol and methylene blue (MLM) (0.6 mL, 1:5) to methylene blue (0.5 mL) in rabbit lungs. CT-guided percutaneous injections were performed in 21 subjects with MLM and methylene blue. We measured the extent of staining on freshly excised lung and evaluated the subjective localization ability with 4 point scales at 6 and 24 hr after injections. For MLM, radio-opacity was evaluated on the fluoroscopy. We considered score 2 (acceptable) or 3 (excellent) as appropriate for localization. The staining extent of MLM was significantly smaller than methylene blue (0.6 vs 1.0 cm, P<0.001). MLM showed superior staining ability over methylene blue (2.8 vs 2.2, P=0.010). Excellent staining was achieved in 17 subjects (81%) with MLM and 8 (38%) with methylene blue (P=0.011). An acceptable or excellent radio-opacity of MLM was found in 13 subjects (62%). An appropriate localization rate of MLM was 100% with the use of the directly visible ability and radio-opacity of MLM. MLM provides a superior pulmonary localization ability over methylene blue.

참고문헌 (Reference)

1 Suzuki K, "Video-assisted thoracoscopic surgery for small indeterminate pulmonary nodules : indications for preoperative marking" 115 : 563-568, 1999

2 Ciriaco P, "Video-assisted thoracoscopic surgery for pulmonary nodules : rationale for preoperative computed tomography-guided hookwire localization" 25 : 429-433, 2004

3 Chen S, "Video-assisted thoracoscopic solitary pulmonary nodule resection after CT-guided hookwire localization: 43 cases report and literature review" 25 : 1723-1729, 2011

4 Pittet O, "Video-assisted thoracoscopic resection of a small pulmonary nodule after computed tomography-guided localization with a hook-wire system: experience in 45 consecutive patients" 31 : 575-578, 2007

5 Watanabe K, "Usefulness and complications of computed tomography-guided lipiodol marking for fluoroscopy-assisted thoracoscopic resection of small pulmonary nodules : experience with 174 nodules" 132 : 320-324, 2006

6 Gossot D, "The hook-wire technique for localization of pulmonary nodules during thoracoscopic resection" 105 : 1467-1469, 1994

7 Bernard A, "Resection of pulmonary nodules using video-assisted thoracic surgery : the Thorax Group" 61 : 202-204, 1996

8 Kamiyoshihara M, "Pulmonary cryptococcosis diagnosed by video-assisted thoracoscopic surgery with CT-guided localization: report of a case" 53 : 795-797, 2000

9 Nakashima S, "Need for preoperative computed tomography-guided localization in video-assisted thoracoscopic surgery pulmonary resections of metastatic pulmonary nodules" 89 : 212-218, 2010

10 McConnell PI, "Methylene blue-stained autologous blood for needle localization and thoracoscopic resection of deep pulmonary nodules" 37 : 1729-1731, 2002

11 Kawanaka K, "Marking of small pulmonary nodules before thoracoscopic resection: injection of lipiodol under CT-fluoroscopic guidance" 16 : 39-45, 2009

12 Mayo JR, "Lung nodules : CT-guided placement of microcoils to direct video-assisted thoracoscopic surgical resection" 250 : 576-585, 2009

13 Hu J, "Localization of small pulmonary nodules for videothoracoscopic surgery" 76 : 649-651, 2006

14 Kim YD, "Localization of pulmonary nodules with lipiodol prior to thoracoscopic surgery" 52 : 64-69, 2011

15 Lenglinger FX, "Localization of pulmonary nodules before thoracoscopic surgery: value of percutaneous staining with methylene blue" 163 : 297-300, 1994

16 Ikeda K, "Impalpable pulmonary nodules with ground-glass opacity : success for making pathologic sections with preoperative marking by lipiodol" 131 : 502-506, 2007

17 Iwasaki Y, "Fluoroscopy-guided barium marking for localizing small pulmonary lesions before video-assisted thoracic surgery" 99 : 285-289, 2005

18 Okumura T, "Fluoroscopy-assisted thoracoscopic surgery after computed tomography-guided bronchoscopic barium marking" 71 : 439-442, 2001

19 Nomori H, "Fluoroscopy-assisted thoracoscopic resection of lung nodules marked with lipiodol" 74 : 170-173, 2002

20 Seo JM, "Factors determining successful computed tomography-guided localization of lung nodules" 143 : 809-814, 2012

21 Yamagami T, "Experience of fluoroscopy-aided thoracoscopic resection of pulmonary nodule localised with Lipiodol in a child" 55 : 401-403, 2011

22 Jang HS, "Effect of drugs for preoperative localization of thoracoscopy to histopathologic change in rabbit lung" Catholic University of Korea 2000

23 Martin AE, "Dual localization technique for thoracoscopic resection of lung lesions in children" 19 : S161-S164, 2009

24 Kwon WJ, "Direct lipiodol injection used for a radio-opaque lung marker : stability and histopathologic effects" 37 : 310-317, 2011

25 Yoshida J, "Computed tomography-fluoroscopy guided injection of cyanoacrylate to mark a pulmonary nodule for thoracoscopic resection" 47 : 210-213, 1999

26 Nomori H, "Colored collagen is a long-lasting point marker for small pulmonary nodules in thoracoscopic operations" 61 : 1070-1073, 1996

27 Vandoni RE, "CT-guided methylene-blue labelling before thoracoscopic resection of pulmonary nodules" 14 : 265-270, 1998

28 Wicky S, "CT-guided localizations of pulmonary nodules with methylene blue injections for thoracoscopic resections" 106 : 1326-1328, 1994

29 이녕근, "CT-Guided Percutaneous Transthoracic Localization of Pulmonary Nodules Prior to Video-Assisted Thoracoscopic Surgery Using Barium Suspension" 대한영상의학회 13 (13): 694-701, 2012

30 Chen W, "A novel technique for localization of small pulmonary nodules" 131 : 1526-1531, 2007