CT-GUIDED METHYLENE-BLUE LABELING BEFORE THORACOSCOPIC RESECTION OF PULMONARY NODULES

Objective: Evaluation of the efficiency of our technique of methylene- blue labelling of pulmonary nodules to facilitate thoracoscopic recogn ition and excision. Design: Patients with a peripheral pulmonary nodul e smaller than 2.5 cm and not in contact with the visceral pleura were included. Under tomodensitometric guidance, the nodules were labelled with methylene-blue within hours before thoracoscopic wedge resection . If frozen section revealed a primary bronchial carcinoma, thoracotom y and classical resection were performed during the same anesthesia. R esults: Between July 1992 and August 1996, 54 nodules were removed in 51 patients. Labelling was performed between 75 and 270 min before sur gery and was complicated in 13 patients (25.4%) by a small pneumothora x without any clinical consequence. Labelling allowed successful thora coscopic recognition of 50 nodules (92%) and thoracoscopic wedge resec tion was possible in all but one cases (91%). Five patients (9%) requi red thoracotomy. Histology showed a benign lesion in 22 cases, a prima ry lung carcinoma in 17 and a metastases in 15. Twenty of the 22 benig n nodules (91%) were removed without thoracotomy. According to the pro tocol, 13 patients with a primary lung tumour underwent lobectomy duri ng the same session. There was no mortality nor morbidity amongst pati ents who had thoracoscopy only. Conclusions: Our technique of labellin g peripheral pulmonary nodules with methylene-blue is very effective a nd is not associated with any relevant complication. Thoracoscopic exc ision and diagnosis is possible in more than 90% of the cases. We ther efore recommend this simple, low-cost and reliable technique for nodul es not in contact with the visceral pleura before thoracoscopic wedge resection. (C) 1998 Elsevier Science B.V. All rights reserved.