Localization of small pulmonary ground glass opacity before single-port video-assisted thoracoscopic resection: Value of CT-guided injection of sclerosing agents

Objective To explore the feasibility and safety of CT-guided localization with injection of sclerosing agents and singleport video-assisted thoracoscopic resection of small pulmonary ground glass opacity. Methods Clinical data about 16 patients(20 nodules) with small pulmonary ground glass opacity in our department from June 2016 to October 2017 were retrospectively analyzed. CT-guided localization with injection of sclerosing agents was performed via percutaneous puncture of lung tissue under local anesthesia, and then single-port video-assisted thoracoscopic resection of pulmonary focuses was carried out under general anesthesia. According to the rapid pathological examination results, local excision, anatomic segmentectomy or lobectomy was performed. The accuracy of localization, surgical strategies, and complications were evaluated in this study. Results Twenty small pulmonary ground glass opacity focuses were all located at sub-pleural (CT scan), and no change was observed in the pleural. The average diameter of the nodules was (8.44±6.55) mm, and the distance from the edge of the lesion to the pleural was (8.19±2.72) mm.Nineteen nodules that were located by CT guided percutaneous injection of sclerosing agents could be touched during operation with the accuracy rate of localization of 95%. Failure of localization occurred in one case due to displacement resulted from hemorrhage.The average time of puncture and location was (18.55±8.33) min and the average time of surgical excision was (15.31±4.35) min, including 13 cases of wedge excision, 4 cases of segmental resection of lung and 3 cases of lobectomy. No complication was observed after operation. The postoperative pathology showed that 4 cases were invasive adenocarcinoma, 5 cases were minimally invasive adenocarcinoma (MIA), 3 cases were adenocarcinoma in situ, 5 cases were atypical hyperplasia (AAH), and 3 cases were fibrous hyperplasia and inflammation. Conclusion It is a safe and accurate way to treat small pulmonary ground glass opacity by CT guided percutaneous localization with injection of sclerosing agents combined with single-port video-assisted thoracoscopic resection.