Imaging characteristics and surgical methods of pulmonary nodules located in external lung 1/3 group versus internal lung 2/3 group_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Dehao ^1,2 , LIAO Liangzhong ³ , LI Puchen ¹ , LIU Yue ¹ ,  CHEN Lichun ³

1. Department of Radiology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361003, Fujian, P. R. China;
2. The Third Clinical Medical College, Fujian Medical University, Fuzhou, 350122, P. R. China;
3. Department of Radiology, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, 361003, Fujian, P. R. China;

Corresponding author：

CHEN Lichun, Email: chenlichun12141990@163.com

Keywords：

CT-guided localization; pulmonary nodules; video-assisted thoracoscopic surgery; imaging characteristics; surgical method

DOI：

10.7507/1007-4848.202404007

Video：

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Objective To compare the imaging characteristics and surgical methods of pulmonary nodules in the external 1/3 group and internal 2/3 group. Methods A retrospective analysis of clinical data from patients who underwent thoracoscopic preoperative CT-guided lung nodule localization at the Department of Radiology, the First Affiliated Hospital of Xiamen University from September 2020 to April 2022 was conducted. Results A total of 215 patients were enrolled (247 pulmonary nodules), including 70 males and 145 females, with a median age of 48.0 years. Based on the location of the nodules under CT guidance, those located in the external 1/3 area of the lung were classified into an external 1/3 group, while those located in the middle 1/3 and inner 1/3 areas were classified into an internal 2/3 group. There was no statistical difference between the two groups in terms of general clinical data, nature of pulmonary nodules, distribution of pulmonary nodules in lobes, localization time, and localization complications (P>0.05). However, there were statistical differences in the distance of pulmonary nodules from the pleura [0.6 (0.0-1.9) cm vs. 1.8 (0.0-4.5) cm, P<0.001], size of pulmonary nodules [0.7 (0.2-1.8) cm vs. 1.0 (0.2-2.0) cm, P<0.001], and surgical methods (P=0.002). In the external 1/3 group, 92.1% of nodules underwent thoracoscopic wedge resection, while fewer patients underwent other procedures; in the internal 2/3 group, 77.1% of nodules underwent thoracoscopic wedge resection, and 19.3% underwent segmentectomy. Conclusion The diameter of pulmonary nodules, the distance of pulmonary nodules from the pleura, and surgical methods differ between the external 1/3 group and internal 2/3 group. Thoracic surgeons can develop more precise surgical plans based on the location and size of pulmonary nodules.

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12.	Dias M, Linhas R, Campainha S, et al. Lung cancer in never-smokers: What are the differences? Acta Oncol, 2017, 56(7): 931-935.
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1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2. 刘志敏, 祁佩红. 低剂量与常规剂量CT在肺磨玻璃影结节鉴别和浸润性诊断中的应用比较. 中国CT和MRI杂志, 2023, 21(11): 47-49.Liu ZM, Qi PH. Comparison of low-dose CT and conventional dose CT in the differentiation and invasive diagnosis of pulmonary ground glass nodules. Chin J CT MRI, 2023, 21(11): 47-49.
3. 孙莲, 马红萍, 吴文英. 肺结节诊断及手术治疗的研究进展. 标记免疫分析与临床, 2023, 30(8): 1431-1434,1440.Sun L, Ma HP, Wu WY. The Research Progress in the Diagnosis and Surgical Treatment of Pulmonary Nodules. Label Immunoass Clin Med, 2023, 30(8): 1431-1434,1440.
4. 肺小结节术前辅助定位技术专家共识(2019版)专家组. 肺小结节术前辅助定位技术专家共识(2019版). 中国胸心血管外科临床杂志, 2019, 26(2): 109-113.Writing Committee of Expert Consensus on Preoperative Auxiliary Localization Techniques for Pulmonary Nodules. Expert consensus on preoperative auxiliary localization techniques for pulmonary nodules. Chin J Clin Thorac Cardiovasc Surg, 2019, 26(2): 109-113.
5. Ettinger DS, Wood DE, Aisner DL, et al. Non-small cell lung cancer, version 3. 2022, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2022, 20(5): 497-530.
6. 张华, 郭坚溪, 孔健. 肺小结节胸腔镜切除术前定位方法的应用进展. 介入放射学杂志, 2022, 31(12): 1216-1221.Zhang H, Guo JX, Kong J. Advances in the application of preoperative localization methods in thoracoscopic resection of small pulmonary nodules. J Interv Radiol, 2022, 31(12): 1216-1221.
7. 中国医药教育协会肺癌医学教育委员会. 肺结节多学科微创诊疗中国专家共识. 中国胸心血管外科临床杂志, 2023. [Epub ahead of print].Lung Cancer Medical Education Committee of China Medical Education Association. Chinese experts consensus on multidisciplinary minimally invasive diagnosis and treatment of pulmonary nodules. Chin J Clin Thorac Cardiovasc Surg, 2023. [Epub ahead of print].
8. Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet, 2022, 399(10335): 1607-1617.
9. 李波. 胸腔镜下解剖性肺段切除术与肺楔形切除术治疗Ⅰ期NSCLC的临床效果对比. 中国实用医药, 2023, 18(12): 5-8.Li B. Comparison of the clinical effect of thoracoscopic anatomical segmentectomy and pulmonary wedge resection in the treatment of stageⅠNSCLC. China Pract Med, 2023, 18(12): 5-8.
10. 陈国标, 周建平, 杜巍, 等. 胸腔镜肺楔形切除术、胸腔镜下肺段切除术、胸腔镜肺叶切除术治疗早期肺癌的疗效比较研究. 实用心脑肺血管病杂志, 2022, 30(4): 23-28.Chen GB, Zhou JP, Du W, et al. Comparative study on the curative effect of thoracoscopic lung wedge resection, thoracoscopic segmentectomy and thoracoscopic lobectomy in the treatment of early stage lung cancer. Pract J Card Cereb Pneum Vasc Dis, 2022, 30(4): 23-28.
11. Liu D, Zhang R, Yu X, et al. Comparison of two methods for CT-guided pulmonary nodule location before thoracoscopic surgery. Wideochir Inne Tech Maloinwazyjne, 2023, 18(4): 680-689.
12. Dias M, Linhas R, Campainha S, et al. Lung cancer in never-smokers: What are the differences? Acta Oncol, 2017, 56(7): 931-935.
13. Dubin S, Griffin D. Lung cancer in non-smokers. Mo Med. 2020, 117(4): 375-379 .
14. Mederos N, Friedlaender A, Peters S, et al. Gender-specific aspects of epidemiology, molecular genetics and outcome: Lung cancer. ESMO Open, 2020, 5(Suppl 4): e000796.
15. 梁敏, 吴宁. 女性肺癌的危险因素和筛查现状. 国际医学放射学杂志, 2022, 45(5): 539-544.Liang M, Wu N. Risk factors and screening of lung cancer in women. Int J Med Radiol, 2022, 45(5): 539-544.

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