Spot OnTake-Home Points

Bryan S. Benn, MD, PhD; Hasnain Bawaadam, MD, MPH; Elizabeth M. Colwell, MD; Matthew D. Peterson, PA-C; William B. Tisol, MD; Abesh Niroula, MD; Wissam S. Jaber, MD; Onkar V. Khullar, MD; Kelly Daymude, AGACNP-BC, MSN, CCRN; Chinh T. Phan, DO; Luis A. Godoy, MD; Devon Anderson, MD; Michelle Lagana, RN, BSN; Elizabeth A. Yu, MD, PhD; Tomomi Oka, MD; Mendy Lum, BS, RRT; Pallav L. Shah, MD; Ganesh Krishna, MD

doi:10.1016/j.chpulm.2024.100131

CHEST Pulmonary (Mar 2025)

Spot OnTake-Home Points

Bryan S. Benn, MD, PhD,
Hasnain Bawaadam, MD, MPH,
Elizabeth M. Colwell, MD,
Matthew D. Peterson, PA-C,
William B. Tisol, MD,
Abesh Niroula, MD,
Wissam S. Jaber, MD,
Onkar V. Khullar, MD,
Kelly Daymude, AGACNP-BC, MSN, CCRN,
Chinh T. Phan, DO,
Luis A. Godoy, MD,
Devon Anderson, MD,
Michelle Lagana, RN, BSN,
Elizabeth A. Yu, MD, PhD,
Tomomi Oka, MD,
Mendy Lum, BS, RRT,
Pallav L. Shah, MD,
Ganesh Krishna, MD

Affiliations

Bryan S. Benn, MD, PhD: Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH; CORRESPONDENCE TO: Bryan S. Benn, MD, PhD
Hasnain Bawaadam, MD, MPH: Department of Interventional Pulmonary and Critical Care Medicine, Advocate Aurora Medical Center, Kenosha, WI
Elizabeth M. Colwell, MD: Department of Cardiothoracic Surgery, Advocate Aurora St Lukes Medical Center, Milwaukee, WI
Matthew D. Peterson, PA-C: Department of Interventional Pulmonary and Critical Care Medicine, Advocate Aurora Medical Center, Kenosha, WI
William B. Tisol, MD: Department of Cardiothoracic Surgery, Advocate Aurora St Lukes Medical Center, Milwaukee, WI
Abesh Niroula, MD: Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA
Wissam S. Jaber, MD: Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA
Onkar V. Khullar, MD: Division of Cardiothoracic Surgery, Emory University, Atlanta, GA
Kelly Daymude, AGACNP-BC, MSN, CCRN: Emory Healthcare, Atlanta, GA
Chinh T. Phan, DO: Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Sacramento, CA
Luis A. Godoy, MD: Division of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, Sacramento, CA
Devon Anderson, MD: Division of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, Sacramento, CA
Michelle Lagana, RN, BSN: Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Sacramento, CA
Elizabeth A. Yu, MD, PhD: Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, CA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Palo Alto, CA
Tomomi Oka, MD: Department of Cardiothoracic Surgery, Palo Alto Medical Foundation, Palo Alto, CA
Mendy Lum, BS, RRT: Respiratory Medicine, El Camino Hospital, Mountain View, CA
Pallav L. Shah, MD: Royal Brompton Hospital, London, England; National Heart & Lung Institute, Imperial College, London, England
Ganesh Krishna, MD: Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, CA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Palo Alto, CA

DOI: https://doi.org/10.1016/j.chpulm.2024.100131
Journal volume & issue: Vol. 3, no. 1
p. 100131

Abstract

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Background: Peripheral pulmonary lesions (PPLs) are increasingly identified and often require a tissue diagnosis to guide treatment. Although a surgical resection may combine diagnosis and treatment, it may lead to excessive healthy tissue being removed if the lesion is difficult to localize. Bronchoscopic PPL marking before surgery facilitates this process, but it is limited by current technologies. Advances in procedural techniques may improve this process. Research Question: What is the impact of using indocyanine green-soaked fiducial markers (ICG-Fs) to mark PPLs before surgery compared with unmarked resected PPLs? Study Design and Methods: A retrospective review of patients from 4 institutions with PPLs undergoing bronchoscopy with ICG-F marking (54 nodules) before resection were compared with unmarked nodules (63 nodules). Demographic data, nodule characteristics, procedural and surgical information, and final pathology results were obtained. Results: Demographics were similar between the groups. PPLs were smaller in the ICG-F marked group (axial: ICG-F marked: 14.39 ± 5.39 vs unmarked: 20.31 ± 14.24 mm; P = .0036; coronal: ICG-F marked: 12.66 ± 5.13 vs unmarked: 16.43 ± 10.51 mm; P = .0214). All ICG-F marked lesions were visible with illumination at surgery immediately after bronchoscopy or up to 13 days later. Mean weight (58 ± 77 vs 145 ± 80 g; P < .001) and size (9.07 ± 6.0 × 4.73 ± 3.6 × 2.42 ± 1.23 vs 14.63 ± 6.08 × 8.70 ± 4.36 × 4.08 ± 1.94 mm; P < .001 for all) of the resected ICG-F specimens were significantly decreased compared with unmarked PPLs. Operative time was increased in the ICG-F marked group (165 ± 53 vs 136 ± 43 minutes; P = .0021). Interpretation: Our findings indicate that ICG-F is a safe and accurate procedure to facilitate lung sparing surgery of otherwise undetectable PPLs immediately after bronchoscopic placement or up to 13 days later.

Published in CHEST Pulmonary

ISSN: 2949-7892 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the respiratory system
Website: https://www.sciencedirect.com/journal/chest-pulmonary

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