Radioguided Occult Lesion Localization for small intraparenchymal or nonpalpable lung lesions (ROLL-LUNG). Preliminary results

245 Objectives Peripheral subpleural solitary pulmonary nodules can be visualized and resected easily at thoracoscopy , but it is very difficult to localize deep non-palpable pulmonary nodules that lie in lung parenchyma. The aim of this study is to evaluate usefulness of Radioguided Occult Lesion Localization (ROLL) for intraparenchymal or non-palpable lung lesions. Methods This is a prospective study performed from May 2014 to October 2015. 7 patients (Male 5/7, Mean age 64[SD 14,3]) with suspicious small intraparenchymal or non-palpable lung lesions were offered and consented to the procedure as part of a single diagnostic-therapeutic minimally-invasive surgical approach. The day before or the same day, underwent computed tomography (CT)-guided injection of a solution, composed of 0.2 ml 99mTc-labeled human serum albumin microspheres (1-5 mCi) and 0.1 ml nonionic contrast, into the nodule or into the area just in contact with it, using a 25 G needle. The site of injection were confirmed CT scan and scintigraphy image. Intraoperative lesion were localized and excised during surgery using a laparoscopic gamma probe, followed by frozen-section analysis. Results No complications were reported after the injection. The diameter of nodules ranged from 4-26 mm as measured by CT. In 6/7 cases the gamma-detection was successful and 1 case was considered unsuccessful because the most of the activity was detected in the chest wall but a puncture mark in the lung allowed for a successful localization of the lesion. Five of seven cases, who revealed primary lung cancer (3 papillar and 2 lepidic) after frozen-section examination, underwent video-assisted thoracoscopic lobectomy except for one case in which lobectomy was performed with a full robotic technique. One case showed metastasis and other case revealed benign lesion (see table) Conclusions Our initial results demonstrate that ROLL guided by CT is useful and simple technique for complete excision undiagnosed lung lesions, particularly in small intraparenchymal or non-palpable ones. ROLL LUNG procedure avoids problems such as wire-guide dislodgment and dye diffusion