Radio-Guided Surgery Effectively Removes Lung Nodules

Using miniscule spheres of radioactive liquid to guide surgeons as they remove potentially cancerous single pulmonary nodules in the lungs is safe and more effective than other techniques, according to a new study.

Researchers at Santa Croce e Carle Hospital (Cuneo, Italy) used radio-guided surgery to locate single pulmonary nodules identified in 19 patients. To do so, they first inserted a needle into the lung to reach the lesion; a computerized tomography (CT) scan carried out while the needle was in place confirmed its exact position. They then injected through the needle a solution of 0.3 mL of microspheres of human albumin serum labeled with Technetium (^99mTc). After injection, they used another CT scan and a technique called gamma scintigraphy--which visualizes the gamma radiation being emitted by the radioactive isotope--to confirm precise staining of the nodule. During surgery, to remove it, the researchers used a gamma detector probe to ensure they had removed all the radiolabeled tissue.

The researchers found that the technique was able to localize nodules in all 19 patients; on average, it took 6 minutes to detect the nodule with the gamma probe. Further analysis of the tissue that had been removed showed that it was a primary lung cancer in eight cases, and a secondary lesion in four cases; the remaining seven patients were found to have benign nodules. There were no complications during or after surgery. The study was presented at the European Multidisciplinary Conference in Thoracic Oncology (EMCTO), held during February 2011 in Lugano (Switzerland).

"Such lesions are usually peripheral, making bronchoscopic approaches to diagnosis unsuccessful, while the accuracy of CT-guided biopsy is hindered by the small diameter and by the patient's respiratory movements during the exam,” explained coauthor and study presenter Alberto Terzi, MD. "The use of video-assisted thoracoscopic surgery (VATS) is limited by the difficulty in localizing small, deep, or nonsolid lung nodules where direct finger palpation may not be possible during surgery. Radio-guided thoracoscopy seems to be an effective procedure with fewer complications and failures than other techniques.”

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