CT-GUIDED NEEDLE LOCALIZATION OF LUNG NODULES FOR THORACOSCOPIC RESECTION

We used CT to guide positioning of hook-wires within 19 lung nodules i n order to localize them prior to thoracoscopic surgery. Both Hawkins III and Kopans-type needles with internal hookwires were employed. Nod ule diameter ranged between 0.7 and 4 cm (mean 1.7 cm), and depth from the site of entry of the needle into the pleural surface ranged from 0.5 to 8 cm. Needles were advanced using a technique identical to that for CT-guided biopsy, and localization proved successful in 18 of 19 cases. During surgery, dislodgement of the guidewire occurred in 5 cas es, probably due to traction manoeuvers on it. In all these cases the hook of the wire had been opened within the nodule. No dislodgement oc curred in patients in whom the needle had been advanced beyond the nod ule and the hook allowed to open in the pulmonary parenchyma deep to i t. Severe complications did not occur: there was moderate pleuritic pa in in 16 cases and asymptomatic pneumothorax in 13 patients. Computer- tomography-guided needle localization of lung nodules is a safe and re latively easy procedure that allows thoracoscopic surgery of lesions w hich otherwise might be impossible to locate and resect.