Percutaneous localisation of pulmonary nodules prior to video-assisted thoracoscopic surgery using methylene blue and TC-99

The widespread use of computed tomography (CT) scans for evaluating patients has resulted in the detection of many small solitary pulmonary nodules of uncertain significance. Workup of these nodules can be expensive and emotionally draining, especially in patients who have an established diagnosis of malignancy. Since the early 1990s, video-assisted thoracoscopic surgery ( VATS) has become a procedure of choice in the workup and therapy of small lung lesions. Many different techniques have been described that would assist surgeons in localising small nondescript lesions in the lung during VATS. Most commonly, a single agent or mechanical device has been used for tumour localisation. We have modified the existing pre-VATS localisation techniques, evolving from one single agent with single spot injection to a dual-agent approach. In this approach, each agent is injected at two different locations. This technique provides us with a more precise 'linear projection' to the lesion of interest rather than the vague 'field localisation' provided by a single agent with a single spot injection. This modified dual agent's preoperative localisation is logical, practical and easy to be adopted into the clinical setting for surgeons who choose to use the VATS technique in addressing these lung nodules. (C) 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.