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Peer-reviewedCC BY-NC-NDThoracic cancer

Nodule Dye-Localization Using Interventional Fluoroscopy for Image-Guided Sublobar Lung Resection.

  • Yueh-Lin Wu1
  • Kam-Hong Kam1,2
  • Chi-Yen Liang3
  • Yu-Ting Lai3
  • Tien-Hsin Jeng3
  • Chang-Ching Lee3
  • Ya-Fen Wu1
  • Yung-Cheng Yang4
  • Hsin-Yi Yang5
  • Jia-Ming Chang1,6
6 affiliations
  1. 1Division of Thoracic Surgery, Department of Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan.
  2. 2Department of Biomedical Sciences, National Chung Cheng University, Chia-Yi, Taiwan.
  3. 3Division of Pulmonary Medicine, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan.
  4. 4Department of Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan.
  5. 5Clinical Data Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan.
  6. 6Institute of Molecular Biology, National Chung Cheng University, Chia-Yi, Taiwan.
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Abstract

Background

Precise localization is critical for sublobar resection of small pulmonary nodules. We evaluated the safety, technical efficiency, and clinical outcomes of preoperative percutaneous dye-localization using a cone-beam computed tomography (CBCT)-enabled flat-panel detector interventional fluoroscopy system in a hybrid operating room (HOR).Methods

We retrospectively reviewed 74 consecutive patients (137 lesions) who underwent image-guided localization followed by video-assisted thoracoscopic surgery (VATS) sublobar resection (wedge resection or segmentectomy) between 2022 and 2023 at Chia-Yi Christian Hospital. Procedural workflow, localization success, surgical margins, and perioperative outcomes were systematically analyzed.Results

Technical localization success was achieved in 100% of lesions (mean nodule diameter: 8.59 ± 4.85 mm). The procedure required a mean of 1.31 ± 0.67 puncture attempts per lesion at a mean depth of 5.22 ± 1.86 cm. Procedure-related pneumothorax occurred in 29.7% (22/74) of patients, with 14.9% (11/74) requiring pigtail catheter drainage; pneumothorax occurrence was significantly associated with multiple puncture attempts (p < 0.001) and lower-lobe lesions (p = 0.001). Lower-lobe location was significantly associated with requiring more puncture attempts (p = 0.028). For malignant lesions, the mean pathological resection margin was 17.16 ± 8.73 mm, with 92.31% achieving a margin-to-tumor ratio (MTR) ≥ 1. The mean postoperative hospital stay was 3.04 ± 1.16 days.Conclusions

Single-stage image-guided dye-localization and VATS sublobar lung resection in an HOR using a biplane CBCT-enabled platform is safe, feasible, and effective. This streamlined workflow ensures high technical success and adequate surgical margins with manageable complications. Further studies are warranted to evaluate long-term oncological outcomes.

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Cite

BibTeXRIS
BibTeX
@article{wu2026nodule,
  title = {{Nodule Dye-Localization Using Interventional Fluoroscopy for Image-Guided Sublobar Lung Resection.}},
  author = {Yueh-Lin Wu and Kam-Hong Kam and Chi-Yen Liang and Yu-Ting Lai and Tien-Hsin Jeng and Chang-Ching Lee and Ya-Fen Wu and Yung-Cheng Yang and Hsin-Yi Yang and Jia-Ming Chang},
  journal = {Thoracic cancer},
  year = {2026},
  month = oct,
  doi = {10.1111/1759-7714.70401},
  url = {https://europepmc.org/article/MED/42885537},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Nodule Dye-Localization Using Interventional Fluoroscopy for Image-Guided Sublobar Lung Resection.
AU  - Yueh-Lin Wu
AU  - Kam-Hong Kam
AU  - Chi-Yen Liang
AU  - Yu-Ting Lai
AU  - Tien-Hsin Jeng
AU  - Chang-Ching Lee
AU  - Ya-Fen Wu
AU  - Yung-Cheng Yang
AU  - Hsin-Yi Yang
AU  - Jia-Ming Chang
PY  - 2026
DA  - 2026/10/01
JO  - Thoracic cancer
DO  - 10.1111/1759-7714.70401
UR  - https://europepmc.org/article/MED/42885537
AB  - Background  Precise localization is critical for sublobar resection of small pulmonary nodules. We evaluated the safety, technical efficiency, and clinical outcomes of preoperative percutaneous dye-localization using a cone-beam computed tomography (CBCT)-enabled flat-panel detector interventional fluoroscopy system in a hybrid operating room (HOR).Methods  We retrospectively reviewed 74 consecutive patients (137 lesions) who underwent image-guided localization followed by video-assisted thoracoscopic surgery (VATS) sublobar resection (wedge resection or segmentectomy) between 2022 and 2023 at Chia-Yi Christian Hospital. Procedural workflow, localization success, surgical margins, and perioperative outcomes were systematically analyzed.Results  Technical localization success was achieved in 100% of lesions (mean nodule diameter: 8.59 ± 4.85 mm). The procedure required a mean of 1.31 ± 0.67 puncture attempts per lesion at a mean depth of 5.22 ± 1.86 cm. Procedure-related pneumothorax occurred in 29.7% (22/74) of patients, with 14.9% (11/74) requiring pigtail catheter drainage; pneumothorax occurrence was significantly associated with multiple puncture attempts (p < 0.001) and lower-lobe lesions (p = 0.001). Lower-lobe location was significantly associated with requiring more puncture attempts (p = 0.028). For malignant lesions, the mean pathological resection margin was 17.16 ± 8.73 mm, with 92.31% achieving a margin-to-tumor ratio (MTR) ≥ 1. The mean postoperative hospital stay was 3.04 ± 1.16 days.Conclusions  Single-stage image-guided dye-localization and VATS sublobar lung resection in an HOR using a biplane CBCT-enabled platform is safe, feasible, and effective. This streamlined workflow ensures high technical success and adequate surgical margins with manageable complications. Further studies are warranted to evaluate long-term oncological outcomes.
SN  - 1759-7706
SN  - 1759-7714
ER  -