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Ann Thorac Surg 2005;79:2197
© 2005 The Society of Thoracic Surgeons

Correspondence

Present and Future Applications of Radio-Guided Technique

Davide Sortini, MD, Carlo V. Feo, MD, Paolo Carcoforo, MD, Kostantinos Maravegias, MD, Enzo Pozza, MD, Alberto Liboni, MD, Andrea Sortini, MD

Section of General Surgery, Department of Surgical, Anaesthesiological and Radiological Sciences, University of Ferrara, C.so Giovecca 203, Ferrara 44100, Italy

(E-mail: sors{at}libero.it).

To the Editor:

We would like to comment on the article by Daniel and associates [1]. We congratulate the authors on the well-conducted study, with experimental studies followed by human application. Most notably, it seems that the authors have solved the problem [2, 3] with the use of a radio-guided technique to locate pulmonary nodules. However, we have some questions and remarks.

We agree that macroaggregated albumin does not spread into perinodular lung parenchyma, and localizes radioactivity, which is an advantage compared with other tracers. Regarding surgical technique and histopathology, did Daniel and associates search for the sentinel node or did they only use the radio-guided technique to locate the pulmonary nodule? We think that the main advantage of the radio-guided technique is to locate a sentinel node in patients with very small pulmonary nodules or to guide lymphoadenectomy, to detect N2 lung cancer [4]. Did the authors see hematoma intraoperatively, or in the specimen after injection of macroaggregated albumin [3]? The majority of the pulmonary nodules described in the article were close to the pleural surface, and we wonder whether any preoperative localization technique was needed [5]. In fact, 8 of 13 nodules (61%) were within 1 cm of the pleural surface. Preoperative localization should not be necessary, because complete deflation of the lung would allow localization. The authors also report a nodule deeper than 4 cm; in our opinion, this patient should have had a lobectomy because wedge resection removes considerable parenchyma.

In our opinion, intrathoracoscopic ultrasonography can locate pulmonary nodules not seen by chest computed tomography and offers several advantages over other preoperative localization techniques. Ultrasonography is simple and quick, and is the only technique without side effects or complications [3].

Lastly, we would like to know the authors’ opinion about the ultrasound rotary probe. In our experience, missed localizations were limited to posterior and deep nodules, owing to the size and rigidity of the ultrasound probe. Therefore, we think that a rotary probe could be of help [3].


   References
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 References
 

  1. Daniel TM, Altes TA, Rehm PK, et al. A novel technique for localization and excisional biopsy of small or ill-defined pulmonary lesions Ann Thorac Surg 2004;77:1756-1762.[Abstract/Free Full Text]
  2. Chella A, Lucchi M, Ambrogi MC, et al. A pilot study of the role of TC-99 radionuclide in localization of pulmonary nodular lesions for thoracoscopic resection Eur J Cardiothorac Surg 2000;18:17-21.[Abstract/Free Full Text]
  3. Sortini D, Feo CV, Carrella G, et al. Thoracoscopic localization’s techniques for patients with single pulmonary nodule and positive oncological anamnesis. A prospective study J Laparoendosc Adv A 2003;13:371-375.
  4. Choi YS, Shim YM, Kim J, Kim K. Mediastinoscopy in patients with clinical stage I non-small cell lung cancer Ann Thorac Surg 2003;75:364-366.[Abstract/Free Full Text]
  5. Susuky K, Nagai K, Yoshida J, et al. Video-assisted thoracoscopic surgery for small indeterminate pulmonary nodulesindication for preoperative marking. Chest 1999;115:563-568.[Medline]

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Reply
Thomas Daniel
Ann. Thorac. Surg. 2005 79: 2197. [Extract] [Full Text] [PDF]




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