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A novel CT-guided technique using medical adhesive for localization of small pulmonary ground-glass nodules and mixed ground-glass nodules (≤20 mm) before video-assisted thoracoscopic surgery.

PURPOSE
We aimed to evaluate the success rate and complication occurrence of CT-guided localization of small pure ground-glass nodules (pGGNs) and mixed ground-glass nodules (mGGNs) with medical adhesive injection before video-assisted thoracoscopic surgery (VATS).


METHODS
From March 2015 to May 2017, 41 patients with 44 small pGGNs and mGGNs underwent CT-guided percutaneous localization with medical adhesive prior to wedge resection by VATS.


RESULTS
Localization with medical adhesive was successful in all patients (100%). The nodules (13 pGGNs, 31 mGGNs) had a mean maximal long-axis diameter of 9±4 mm and a mean distance of 10±7 mm from the most superficial edge of the nodule to the visceral pleura. The localization time was 16±8 minutes. There was a moderate inverse relationship between localization time and the nodule diameter (r= -0.42, P = 0.005). Thirty-three nodules with primary lung cancer were pathologically confirmed. There were 3 cases of pneumothorax (7%), 3 cases of parenchyma hemorrhage (7%) and 2 cases of irritable cough (5%), respectively. No conversion to thoracotomy was necessary in any patient.


CONCLUSION
CT-guided percutaneous localization with medical adhesive can label small pGGNs and mGGNs prior to VATS, with high success and low complication rates.