The use of iodine seed (I-125) as a marker for the localisation of lung nodules in minimal invasive pulmonary surgery.

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

PubMedID: 23850089

Gobardhan PD, Djamin RS, Romme PJ, de Wit PE, de Groot HG, Adriaensen T, Turkenburg JL, Veen EJ. The use of iodine seed (I-125) as a marker for the localisation of lung nodules in minimal invasive pulmonary surgery. Eur J Surg Oncol. 2013;39(9):945-50.
AIM
Video assisted thoracic surgery (VATS) is an important tool in the field of thoracic pathology both for therapeutic and diagnostic purposes. The standard technique for localisation of non-visible or non-palpable lung lesions is the use of image guided insertion of a guide-wire. However, this method is associated with complications such as pneumothorax, bleeding and wire-dislocation. The aim of this study was to investigate the feasibility of using of iodine seeds (I-125) as a marker of lung lesions during VATS.

METHODS
28 consecutive patients with parenchymal lung lesions had I-125 seed localisation performed prior to VATS. After seed placement all patients underwent VATS with wedge resection.

RESULTS
During surgery all lesions could be identified and radically resected. In six (21.4%) patients the seed was not placed optimally but none of these cases were associated with seed dislocation after placement. In four and in 5 patients the placement of the I-125 seed was complicated by a haematoma and pneumothorax respectively. However, in all of these patients a wait-and-see policy would have been justified. In one patient a conversion to a thoracotomy was necessary due to seed displacement.

CONCLUSION
In patients with parenchymal lung lesions undergoing VATS and wedge resection I-125 seed localisation is a feasible technique. Complication rates are comparable to standard guide-wire localisation. Although I-125 seeds can be positioned under CT-guidance an optimal placement is of utmost importance for VATS wedge resection. Further research is needed to investigate the possible advantages of this technique.