Commentary on the article “Radioguided video-assisted resection of non-palpable solitary pulmonary nodule/ground glass opacity: how to do it”

The article describes the radioguided localization technique of small lesions (maximum nodule diameter <15 mm, distance from the nearest pleural surface of 20–40 mm) or ground glass opacities (GGO) to identify and resect them by video-assisted thoracoscopic surgery (VATS) (1). This technique enables the possibility of using the VATS approach in order to localize lesions, which are often too small to be recognised by digital palpation, and which would otherwise require a thoracotomy for diagnostic purposes. First step is the CT-guided injection of a solution of ^99mtechnetium macro-aggregate albumin diluted with iodized contrast medium. This allows the stability of the radiotracer in the lung for up to 18 hours for an optimal planning of the surgical resection. A CT scan was performed to confirm the precise staining. Then a VATS with three ports was performed and the gamma detector was inserted inside the chest to localize the tracer and the parenchyma was grasped in its correspondence. After a double check of the tracer’s position with the gamma detector, the resection was performed and the sample was sent for histologic examination (frozen section). In case of diagnosis of lung cancer, a VATS lobectomy was performed.