474P - The efficacy of image guided coil localisation for surgical resection of undiagnosed solitary lung nodule

Background

Good overall and disease-free survival for small primary lung cancers may be achieved with sublobar resections. These cancers presented as undiagnosed solitary lung nodule and may be difficult to localise intra-operatively due to their size or their ground glass nature, necessitating a greater anatomical resection. Our institution had adopted the use of image guided coil localisation since 2017 to aid the excision of such nodules. The localisation was performed on the same day just prior to the lung resection surgery. We aimed to share our experience with this technique.

Methods

We reviewed the outcomes of all patients who underwent surgical excision for undiagnosed solitary lung nodule between 2018 and 2021 and compared the efficacy with patients who had coil localisation and those who did not.

Results

182 consecutive patients were reviewed in our study. 36 patients (19.8%) underwent coil localisation whilst 146 patients (80.2%) did not. There was no significant difference in the pre-operative lung function between the 2 groups of patients. 88.5% of nodules were malignant and there was no significant difference in incidence between both groups (coil 91.7% vs no coil 87.7%, p = 0.368). Lung resection was performed via uniportal video assisted thoracoscopic (UVATS) in all coiling cases whilst 9 non-coiling cases (6.2%) had open thoracotomy. Patients who had coiling were more likely to underwent wedge resection than an anatomical resection (OR 2.14, 95% CI 1.62-2.82, p < 0.001).The conversion rate was lower in patients who had underwent coil localisation (OR 0.72, 95% CI 0.27-1.98) but this was not statistically significant (p = 0.367). All patients who underwent coil localisation reported clear margins on final histology. Patient who underwent coil localisation had a shorter length of stay (mean 3.44 +/- 2.92 days) than those who did not (mean 4.07 +/- 3.21 days) (p = 0.290). There was no significant difference in complications between both group of patients.

Conclusions

Both diagnostic and cure can be achieved via UVATS wedge resection with the aid of coil localisation. Our study demonstrated it as a safe and effective method of managing suspicious small primary lung cancers presenting as a small solitary lung nodule.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.