Locating lesions in the lung

A multidisciplinary team of physicians at the University of Virginia Health System has developed a radioactive technique to find small or ill-defined pulmonary nodules in the lung that can then be removed by video surgery.

A multidisciplinary team of physicians at the University of Virginia (UVa) Health System, led by thoracic surgeon Dr. Thomas Daniel, has developed a radioactive technique to find small or ill-defined pulmonary nodules in the lung that can then be removed by video surgery.

The technique uses a radiotracer substance called macroaggregated albumin (MAA) that is placed by radiologists using a CT scan in or near a suspicious lung nodule the morning of surgery.

After the patient is put to sleep, surgeons then use a sterile radioprobe to guide them to the small or diffuse lesion, which is then removed. Previous animal studies at UVa revealed that MAA, used with a source of gamma radioactivity called technetium-99, stays in the area of the lung lesion for many hours after being inserted by a tiny needle between the ribs and can guide a gamma probe to locate the lesion later on in surgery.

The findings could be important in detecting lung cancer at an early stage, potentially leading to longer survival for patients, especially long-term smokers. Researchers in Italy and Japan have previously used different radiotracers that are not available in the US to localise lung nodules.

“If further clinical use of this technique confirms that it is reliable, with low morbidity and mortality,” Daniel said, “proceeding directly to radiotracer-guided video surgery may become the safest step to take if a patient with a significant smoking history is found to have a solitary, small lung nodule. Presently, most of these patients are advised to have repeat CT scans, an experience that can be very anxiety producing.”