Trans-Scapular Approach Coil Localization for Scapular-Blocked Pulmonary Nodules: A Retrospective Study

Abstract

Background: Preoperative computed tomography (CT)-guided coil localization (CL) is commonly employed to facilitate the video-assisted thoracoscopic surgery (VATS)-guided diagnostic wedge resection (WR) of pulmonary nodules (PNs). When a scapular-blocked PN (SBPN) will be localized, the trans-scapular CL (TSCL) should be performed. In this study, we investigated the safety, feasibility, and clinical efficacy of preoperative CT-guided TSCL for SBPNs.

Materials and Methods: From January 2014 to September 2020, a total of 152 patients with PNs underwent CT-guided CL prior to VATS-guided WR. Among them, 14 patients had the SBPNs and underwent TSCL procedure.

Results: A total of 14 SBPNs were localized in the 14 patients. The mean diameter of the 14 SBPNs was 7.4 ± 2.4 mm. Technical success rate of puncture of the scapula was 100%. No complications occurred near the scapula. Technical success rate of CL was 92.9%. One coil dropped off when performing the VATS procedure. The mean duration of the TSCL was 14.2 ± 2.7 min. Two patient (14.3%) developed aysmptomatic pneumothorax after TSCL. Technical success rate of VATS-guided WR was 92.9%. The patient who experienced technical failure of TSCL directly underwent lobectomy. The mean VATS procedure duration and blood loss were 90.0 ± 42.4 min and 62.9 ± 37.2 ml, respectively. The final diagnoses of the 14 SBPNs included invasive adenocarcinoma (n = 4), adenocarcinoma in situ (n = 9), and benign (n = 1).

Conclusions: Preoperative CT-guided TSCL can be safely and simply used to facilitate high successful rates of VATS-guided WR of SBPNs.