Spot On

CHEST pulmonary Pub Date : 2025-03-01 DOI:10.1016/j.chpulm.2024.100131

Bryan S. Benn MD, PhD , Hasnain Bawaadam MD, MPH , Elizabeth M. Colwell MD , Matthew D. Peterson PA-C , William B. Tisol MD , Abesh Niroula MD , Wissam S. Jaber MD , Onkar V. Khullar MD , Kelly Daymude AGACNP-BC, MSN, CCRN , Chinh T. Phan DO , Luis A. Godoy MD , Devon Anderson MD , Michelle Lagana RN, BSN , Elizabeth A. Yu MD, PhD , Tomomi Oka MD , Mendy Lum BS, RRT , Pallav L. Shah MD , Ganesh Krishna MD

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Abstract

Background

Peripheral pulmonary lesions (PPLs) are increasingly identified and often require a tissue diagnosis to guide treatment. Although a surgical resection may combine diagnosis and treatment, it may lead to excessive healthy tissue being removed if the lesion is difficult to localize. Bronchoscopic PPL marking before surgery facilitates this process, but it is limited by current technologies. Advances in procedural techniques may improve this process.

Research Question

What is the impact of using indocyanine green-soaked fiducial markers (ICG-Fs) to mark PPLs before surgery compared with unmarked resected PPLs?

Study Design and Methods

A retrospective review of patients from 4 institutions with PPLs undergoing bronchoscopy with ICG-F marking (54 nodules) before resection were compared with unmarked nodules (63 nodules). Demographic data, nodule characteristics, procedural and surgical information, and final pathology results were obtained.

Results

Demographics were similar between the groups. PPLs were smaller in the ICG-F marked group (axial: ICG-F marked: 14.39 ± 5.39 vs unmarked: 20.31 ± 14.24 mm; P = .0036; coronal: ICG-F marked: 12.66 ± 5.13 vs unmarked: 16.43 ± 10.51 mm; P = .0214). All ICG-F marked lesions were visible with illumination at surgery immediately after bronchoscopy or up to 13 days later. Mean weight (58 ± 77 vs 145 ± 80 g; P < .001) and size (9.07 ± 6.0 × 4.73 ± 3.6 × 2.42 ± 1.23 vs 14.63 ± 6.08 × 8.70 ± 4.36 × 4.08 ± 1.94 mm; P < .001 for all) of the resected ICG-F specimens were significantly decreased compared with unmarked PPLs. Operative time was increased in the ICG-F marked group (165 ± 53 vs 136 ± 43 minutes; P = .0021).

Interpretation

Our findings indicate that ICG-F is a safe and accurate procedure to facilitate lung sparing surgery of otherwise undetectable PPLs immediately after bronchoscopic placement or up to 13 days later.

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背景：周围性肺病变（ppl）被越来越多地识别出来，通常需要组织诊断来指导治疗。虽然手术切除可以结合诊断和治疗，但如果病变难以定位，可能会导致过多的健康组织被切除。术前支气管镜PPL标记促进了这一过程，但受当前技术的限制。程序技术的进步可能会改善这一过程。研究问题在手术前使用吲哚菁绿浸泡基准标记物（ICG-Fs）标记ppl与未标记的切除ppl相比有什么影响？研究设计和方法回顾性分析了来自4家医院的ppl患者，在手术前行支气管镜检查并有ICG-F标记（54个结节）与未标记的结节（63个结节）进行比较。统计资料、结节特征、手术和手术信息以及最终病理结果。结果两组之间的人口统计学特征相似。ICG-F标记组pps较小(轴向：ICG-F标记组：14.39±5.39 vs未标记组：20.31±14.24 mm；P = 0.0036；冠状面：ICG-F标记：12.66±5.13 vs未标记：16.43±10.51 mm；P = .0214)。所有有ICG-F标记的病变在支气管镜检查后立即或13天后手术照明下可见。平均体重（58±77 vs 145±80 g）；P & lt;措施)和大小(9.07±6.0×4.73±3.6×2.42±1.23 vs 14.63±6.08×8.70±4.36×4.08±1.94毫米;P & lt;.001)与未标记的ppl相比，切除的ICG-F标本明显减少。ICG-F标记组手术时间增加（165±53 vs 136±43分钟）；P = .0021)。我们的研究结果表明，ICG-F是一种安全、准确的方法，可在支气管镜置入或13天后立即进行保肺手术，否则无法检测到ppl。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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CHEST pulmonary

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