Page 60 - JCTR-11-2

Journal of Clinical and
Translational Research CT-guided needle versus glue localization

2.4. Localization procedure of medical glue was injected, followed by the aspiration

Prior to the procedure, each patient and his/her family were of 0.1 mL of air to ensure the glue fully entered the lung
explained about the localization process, objectives, risks, tissue and rapidly formed a hard mass. A CT scan was then
and precautions. Informed consent was obtained from performed to confirm the glue mass position and to check
for any complications (Figure 1H-J).
the patient and he/she was instructed to maintain a stable
position and smooth breathing during the procedure. 2.5. VATS surgical procedure
2.4.1. Localization needle group Surgery is typically performed using single-port or
double-port VATS. After administering anesthesia with a
The patient was positioned based on the nodule’s location
(supine, lateral, or prone position). CT scan was performed double-lumen endotracheal tube, the patient was placed
in the lateral decubitus position. The surgical area was
to confirm the nodule’s position and metal markers were used disinfected, and an incision was made at the fifth intercostal
to define the puncture area. Laser guidance was employed to
pinpoint the puncture site, and local infiltration anesthesia space along the mid-axillary line. The thoracoscope
with 2% lidocaine was applied to the planned puncture site. was inserted, and the nodule was identified using the
The localization needle was inserted through the skin into the localization needle tail wire, or, in the case of medical
glue localization, by using instruments or palpation to
lung, ensuring the tip was adjacent to the lesion but not within detect the hardened glue mass. Once the target nodule
it to avoid seeding. The localization needle tail wire was was identified, a partial lung resection (wedge resection
pushed to the chest wall, and then the cannula was withdrawn.
Any complications, such as pneumothorax, pulmonary or segmentectomy) was performed if the nodule is more
hemorrhage, or coughing, were monitored and documented than 20 mm from the lesion’s edge. Intraoperative frozen
section analysis of the resected specimen was conducted
during the procedure (Figure 1A-C). The complication to guide further surgical decisions. For malignant nodules
monitoring protocol was implemented using a multi-step larger than 20 mm, a lobectomy and lymph node dissection
approach. First, an immediate CT scan was performed on were performed. If the nodule was undetected during
completion of the procedure to detect early complications, thoracoscopic surgery, conversion to open thoracotomy
such as pneumothorax and pulmonary hemorrhage. may be necessary. If the resected lung tissue showed no
Approximately 4 h post-procedure, the patient underwent nodule, lobectomy or conversion to open thoracotomy
routine clinical assessments; if new symptoms emerged, may be required.
follow-up imaging via chest X-ray or CT scan was conducted
to further evaluate potential complications. Additionally, 2.6. Data collection and evaluation metrics
during the interval prior to the VATS procedure – typically Clinical data were collected from patients, including
within 24 h – any new or emerging patient symptoms were
promptly assessed, with additional imaging studies performed baseline information (general information, imaging data),
as necessary. All identified complications were meticulously localization operation and complications, and surgical
documented for subsequent analysis. details. General information included gender, age,
smoking history, and history of lung disease. Imaging data
2.4.2. Medical glue group included distance from the nodule to the pleura, nodule
characteristics, nodule location, and size. Localization
Literature reports vary on the dose of medical glue used operation and complications covered localization time
for pulmonary nodule localization. Some studies suggest (from the start of CT scanning to the completion of
an injection volume of 0.5 – 1.0 mL, while others localization), puncture depth, number of punctures
11
recommend 0.2 – 0.3 mL. To determine the medical (1/>1), localization success rate (defined as the final CT
12
glue dose in this study, various doses of medical glue were image showing the localization needle or medical glue
tested in experiments on ex vivo pig lungs (Figure 1D-G): mass adjacent to the nodule, with successful visualization
0.3 mL, 0.5 mL, 0.7 mL, and 0.9 mL. These experiments during VATS or no displacement of the needle or
found that injecting 0.7 mL of medical glue through the detachment), and post-localization complications
puncture needle formed a hard gel particle approximately including pneumothorax (small, moderate, or large),
15 mm in size in pig lungs. The variations in recommended pulmonary hemorrhage (defined as no hemorrhage when
13
doses may be attributed to differences in the diameter and CT imaging showed <1 cm of patchy shadow around the
2
length of the puncture needle used. needle; minor hemorrhage when CT imaging showed
2
In the specific procedure, the puncture needle was increased density of ground-glass shadow ≥1 cm without
inserted into the lung until it was 10 mm from the irritating cough or hemoptysis; major hemorrhage when
nodule. After confirming there was no bleeding, 0.7 mL CT imaging showed ground-glass shadow ≥3 cm or the
2

Volume 11 Issue 2 (2025) 54 doi: 10.36922/JCTR025070007