A study published in Radiology: Cardiothoracic Imaging reports the use of CT-guided fiducial marker placement of pulmonary nodules is not only safe and effective, it also results in a low surgical localization failure rate.
The retrospective analysis of 198 preoperative CT-guided fiducial marker placement procedures performed in 190 patients at Massachusetts General Hospital (MGH) were analyzed. 205 nodules were analyzed from the procedures that extended over a six-year period, from September 2014 to September 2020. The authors reported a technical success rate of CT-guided fiducial marker placement at 98.5%. A low (6%) complication rate of pneumo-thorax that required chest tube placement was noted and the surgical localization failure rate was also low (1 patient, 0.5%).
Preprocedure and postprocedure images were reviewed by two radiologists, an attending interventional thoracic radiologist with five years of experience and a thoracic radiology fellow, blinded to clinical details and outcomes. Primary outcome was defined as the successful deployment of at least one fiducial marker in or within 10 mm of the targeted nodule measured on the final images of the procedure. Secondary outcome was the surgical localization failure rate, defined as the conversion of a planned video-assisted thoracoscopic surgery (VATS) and robot-assisted thoracoscopic surgery (RATS) to an open thoracotomy because of the difficulty in localizing the nodule despite fiducial markers.
No complications were reported in the cohort. A total of 202 nodules were resected during 193 procedures performed five days ± 13 after the fiducial marker placement (range, 0–123 days). Of these, 146 were lung cancers, 26 nodules were metastases, two were carcinoid tumors, and 28 were benign.
The authors noted that to their knowledge, this was the largest study of preoperative CT-guided gold fiducial marker placement and it confirms that CT-guided fiducial marker placement is a safe and easily performed method of preoperative nodule localization.Back To Top
CT-guided Fiducial Marker Placement for Pulmonary Nodules is Safe and Effective. Appl Radiol.