CT-guided percutaneous marking of small pulmonary nodules with [99mTc]Tc-Macrosalb is very accurate and allows minimally invasive lung-sparing resection: a single-centre quality control

Nikola Doncic; Christoph J Zech; Damian Wild; Helga Bachmann; Makhmudbek Mallaev; Nikolay Tsvetkov; Aljaz Hojski; Martin T L Takes; Didier Lardinois

doi:10.1007/s00259-023-06410-1

CT-guided percutaneous marking of small pulmonary nodules with [^99mTc]Tc-Macrosalb is very accurate and allows minimally invasive lung-sparing resection: a single-centre quality control

Eur J Nucl Med Mol Imaging. 2023 Aug 31. doi: 10.1007/s00259-023-06410-1. Online ahead of print.

Authors

Nikola Doncic¹, Christoph J Zech², Damian Wild³, Helga Bachmann¹, Makhmudbek Mallaev¹, Nikolay Tsvetkov¹, Aljaz Hojski¹, Martin T L Takes², Didier Lardinois⁴

Affiliations

¹ Department of Thoracic Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
² Department of Radiology and Nuclear Medicine, Division of Interventional Radiology, University Hospital Basel, Basel, Switzerland.
³ Department of Radiology and Nuclear Medicine, Division of Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
⁴ Department of Thoracic Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland. didier.lardinois@usb.ch.

PMID: 37650931
DOI: 10.1007/s00259-023-06410-1

Abstract

Purpose: The detection of small lung nodules in thoracoscopic procedure is difficult when the lesions are not located within the outer border of the lung. In the case of ground-glass opacities, it is often impossible to palpate the lesion. Marking lung nodules using a radiotracer is a known technique. We analysed the accuracy and safety of the technique and the potential benefits of operating in a hybrid operating room.

Methods: 57 patients, including 33 (58%) females with a median age of 67 years (range 21-82) were included. In 27 patients, we marked and resected the lesion in a hybrid room. In 30 patients, the lesion was marked at the department of radiology the day before resection. [^99mTc]Tc-Macrosalb (Pulmocis^®) was used at an activity of 1 MBq in the hybrid room and at an activity of 3 MBq the day before to get technical feasible results. Radioactivity was detected using the Neoprobe^® detection system.

Results: Precise detection and resection of the nodules was possible in 95% of the lesions and in 93% of the patients. Complete thoracoscopic resection was possible in 90% of the patients. Total conversion rate was 10%, but conversion due to failure of the marking of the nodule was observed in only 5% of the patients. Histology revealed 28 (37%) primary lung cancers, 24 (32%) metastases and 21 (28%) benign lesions. In 13 (23%) patients, minor complications were observed. None of them required additional interventions.

Conclusion: The radio-guided detection of small pulmonary nodules is very accurate and safe after CT-guided injection of [^99mTc]Tc-Macrosalb. Performing the operation in a hybrid room has several logistic advantages and allows using lower technetium-99m activities. The technique allows minimally invasive lung sparing resection and prevents overtreatment of benign and metastatic lesions.

Keywords: CT guided percutaneous marking; Pulmonary nodules; Radio-guided surgery; Video-assisted thoracoscopic surgery; [99mTc]Tc-Macrosalb.