Diagnostic and therapeutic value of computed tomography guided coil placement after digital subtraction angiography guided video-assisted thoracoscopic surgery resection for solitary pulmonary nodules

Yong Qiang, Lei Zhang, Nan Yang, Jian Xu, De-Min Li, Tangfeng Lv, Ping Zhan, Yong Song, Zhong-Dong Li, Hao Li


Purpose: With the widespread use of general health examinations, the detection rate of pulmonary nodules has increased; however, locating the pulmonary nodules is still a challenge.
Description: We reviewed cases that underwent computed tomography (CT)-guided coil localization followed by real-time digital subtraction angiography (DSA)-guided accurate resection of solitary pulmonary nodules (SPNs) using video-assisted thoracoscopic surgery (VATS) at our hospital, and we evaluated the clinical value. From September 2011 to October 2014, 116 cases with SPNs were treated in our unit. The lesion was preoperatively localized using coil placement under CT guidance, and the patients were subsequently transferred to the hybrid operating room. VATS wedge resection with real-time DSA guidance was performed, and further processing was conducted in accordance with the intraoperative pathological diagnosis for these lesions.
Evaluation: Coil localization, which averaged 15.30±3.20 min, was successful in all patients (100%), while VATS wedge resection took 24.20±12.10 min and lobectomy or segmentectomy took 88.8±36 min. The pathological results revealed malignant lesions in 61 cases and benign lesions in 55 cases.
Conclusions: Preoperative CT-guided coil localization for SPNs had a high accuracy with no serious complications. Following real-time DSA-guided VATS resection, the lesions could be accurately removed with a cutting edge distance of >2 cm to the lesion, which may help diagnose and treat the SPN simultaneously.