Study Shows Technique to Be Effective in Identifying Smallest Lung Cancers

Researchers at the UC College of Medicine have found that radiotracer localization is a simple and effective technique to identify and remove small lung nodules in patients undergoing surgery.

These results, reported in the Journal of Thoracic and Cardiovascular Surgery, provide evidence that this technique may be the best way to locate and remove suspicious spots that are detected on a CT scan, leading to better outcomes for patients. 

Radiotracer localization involves a radioactive material being injected in or near a lung nodule—the equivalent of a polyp or suspicious spot in the lung—and a radioprobe is used to pinpoint the location during surgery.

"Multiple localization, or mapping, techniques can help identify small or nonsolid pulmonary nodules during surgery,” says Sandra Starnes, MD, John B. Flege Jr. Chair and professor in the Division of Thoracic Surgery, Department of Surgery, co-director of the Lung Cancer Center at the UC Cancer Institute and principal investigator on this study. "Radiotracer localization has been our preferred method since 2009, but we wanted to see if it was the most effective method. It has been used by a few centers in Europe and infrequently in North America, despite several advantages. Improved understanding of the application and potential technical pitfalls could facilitate greater application of this technique. 

"Currently, the physicians at UC Health are the only ones in the region using this technique which can help us identify and treat even the smallest nodules while we are performing surgery on the patient.”  

Researchers in this study identified all patients undergoing preoperative radiotracer localization using a database. Medical records were retrospectively reviewed for patient demographic characteristics, nodule characteristics, procedure details, pathologic data and outcomes. 

"Seventy-seven patients underwent localization of 79 pulmonary nodules,” Starnes says. "Radiotracer localization had an overall success rate of 95 percent; however, two patients required a second localization procedure on the same day. Most failures occurred in nodules that were less than 5mm from the pleural surface—the membranes around the lungs.”

Starnes adds that the majority (86 percent) of lesions were cancerous and that the average length of stay for patients in the hospital was two days. 

"Radiotracer localization helps in enabling thoracoscopic wedge resections (limited removal of a portion of the lung) and avoiding more invasive and unnecessary lobectomy, removal of the lobes of the lungs, or thoracotomy, creating a surgical incision into the chest wall,” she says. "This technique overcomes some of the disadvantages of other techniques and is simple to implement, requiring no additional expertise on the part of the thoracic surgeon or interventional radiologist.”

She adds that it takes constant communication, collaboration and review of results with multidisciplinary members of the team, like interventional radiologists, to implement and improve this technique. Ross Ristagno, MD, associate professor in the Department of Radiology at UC and section chief of Interventional Radiology for UC Health, is a co-investigator on this study.  

"Localization techniques for small pulmonary nodules will likely become more prevalent with the increase use of CT screening for lung cancer,” Starnes says, noting the small sample size of the study and adding that more studies will need to be done to support these findings. "Radiotracer localization has many advantages over other techniques and can be performed with high success and low risk to the patient.”