Radio-guided op safe, simple way to remove cancerous nodules in lung

WASHINGTON - Italian researchers have suggested that using tiny spheres of radioactive liquid to guide surgeons as they remove potentially cancerous material in the lungs is safe and more effective than other techniques.

Luca Bertolaccini, Alberto Terzi and colleagues from Santa Croce e Carle Hospital in Cuneo, Italy, studied a technique known as radio-guided surgery in 19 patients. Each of the patients had been found to have ’single pulmonary nodules’ in their lungs.

Single pulmonary nodules are solitary abnormalities in the lungs that are smaller than 3 cm in diameter. Improvements in scanning techniques such as computed tomography mean that these very small nodules are becoming more commonly found.

“The problem is that such lesions are usually peripheral, making bronchoscopic approaches to diagnosis unsuccessful, while the accuracy of CT-guided biopsy is hindered by the small diameter and by the patient’s respiratory movements during the exam.

“Video-assisted thoracoscopic surgery (VATS) is nowadays the procedure of choice if we want to surgically biopsy and remove peripheral lung nodules. However, the use of VATS is limited by the difficulty in localizing small, deep, or non-solid lung nodules where direct finger palpation may not be possible during surgery,” said Bertolaccini.

Using radio-guided surgery appears to overcome these problems, the researchers found. First they inserted a needle into the lung to reach the lesion or the lung tissue surrounding it. A CT scan carried out while the needle was in place confirmed its exact position.

Next, they injected a solution of human albumin serum labeled with Technetium-an element that is often used for medical tests. After injection, they used another CT scan and a technique called gamma scintigraphy that visualizes the gamma radiation being emitted by the radioactive isotope to confirm precise staining of the nodule.

During surgery to remove the nodule, the researchers used a gamma detector probe to ensure they had removed all the radio-labeled tissue.

The researchers found that the technique was able to localize nodules in all 19 patients. On average it took 6 minutes to detect the nodule with the gamma probe.

This study shows that radio-guided surgery is a safe and simple technique for localizing single pulmonary nodules, Terzi said. “Radio-guided thoracoscopy seems to be an effective procedure with fewer complications and failures than other techniques.”

The report was presented at the European Multidisciplinary Conference in Thoracic Oncology, Lugano, Switzerland. (ANI)