Pre-Operative Pulmonary Lesion Marking in Preparation for Fluoroscopic Wedge Resection – Rates of Success, Complications and Pathology Outcomes

Publication date: Available online 6 November 2017
Source:Current Problems in Diagnostic Radiology
Author(s): Babatunde Olaiya, Charles A. Gilliland, Seth D. Force, Felix G. Fernandez, Manu S Sancheti, William C. Small
PurposeIn this study, we describe our experience of lesion marking with fiducial markers (FM) and microcoils (MC) facilitating same-day surgical wedge resection, including success rates, pathology outcomes, and complications. We also explored patient/nodular characteristics associated with developing complications.Materials and MethodsAn IRB-approved single institutional retrospective study of 136 patients who had 148 pulmonary nodules was conducted. All patients had CT-guided pulmonary nodule labeling with either FM (121) or MC (15) patients with plan for same-day fluoroscopic-guided wedge-resection.Results133 of 136 (98%) of patients had successful same-day wedge-resection as planned; two had delayed but successful wedge-resection surgery due to complications at the time of marker placement (fiducial embolization and hemorrhage/pneumothorax, respectively). A third patient ultimately needed lobectomy due to deep lesion location. Eighty percent [118/148] of resected nodules were malignant. 68% of the total group of patients [93/136] had mild complications of various types including hemorrhage [44/136, 32%], pneumothorax [35/136, 26%], a combination of both hemorrhage and pneumothorax [10/136, 7%] or migration/embolization [4/136, 3%]. Depth of nodule from skin (p=0.011) and pleura (p=0.027) was significantly associated with complications.ConclusionCT-guided marking of small and/or deep pulmonary lesions using either fiducial markers or microcoils provides an effective means to aid surgeons to accomplish minimally invasive wedge-resection. The importance of the success of this technique is supported by the high incidence (80%) of malignant lesion etiology found at post-resection pathology. Although complications occurred, the vast majority were mild and did not alter planned same-day resection.



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