Overview
Multiple nodules in the lung can indicate various pathologies, including benign conditions like granulomas or malignant tumors such as lung cancer. Accurate diagnosis and localization are crucial for appropriate management.Diagnosis
Imaging: CT scans are essential for initial detection and characterization of lung nodules 12.
Localization Techniques: Mobile CT combined with procedural sedation and analgesia shows higher success rates and lower complication rates compared to local anesthesia alone 2.
Interventional Approaches: Transbronchial interventions are evolving but generally have lower diagnostic yields compared to percutaneous image-guided methods 1.
Coil Localization: Preoperative coil localization under CT guidance is effective for guiding VATS procedures, with a technical success rate of 89.6% 4.
Special Tools: Spiral wire needles offer a stable method for localizing small subpleural nodules, facilitating precise thoracoscopic resection 5.Management
Surgical Resection: Video-assisted thoracoscopic surgery (VATS) with coil localization is recommended for definitive diagnosis and treatment, achieving high technical success rates 4.
Minimally Invasive Techniques: Utilizing interventional radiology tools for transbronchial navigation may offer innovative approaches, though further validation is needed 1.
Anesthesia: Procedural sedation and analgesia combined with local anesthesia improves patient comfort and procedural outcomes compared to local anesthesia alone 2.Special Populations
Comorbidities: No specific recommendations for management in special populations (pregnancy, pediatrics, elderly) are provided in the abstracts.Key Recommendations
Use mobile CT combined with procedural sedation and analgesia for preoperative localization of multiple pulmonary nodules to enhance success rates and reduce complications (Evidence: Strong 2).
Employ coil localization guided by CT for preoperative marking to improve the accuracy and success of VATS procedures (Evidence: Strong 4).
Consider innovative interventional radiology techniques for transbronchial navigation, though current evidence is evolving (Evidence: Moderate 1).References
1 Borde T, Varble NA, Velazquez-Pimentel D, Saccenti L, Baskin AS, Li M et al.. Opportunities for Interventional Radiology in Transbronchial Interventions. Cardiovascular and interventional radiology 2026. link
2 Jiao S, Shao F, Zhang Q, Sun YG. Clinical application of mobile CT combined with procedural sedation and analgesia in the preoperative localization of multiple pulmonary nodules. Langenbeck's archives of surgery 2024. link
3 Goto T. Is tomosynthesis an ingenious scheme for bronchoscopic diagnosis of lung nodules?. Respirology (Carlton, Vic.) 2021. link
4 Fu YF, Zhang M, Wu WB, Wang T. Coil Localization-Guided Video-Assisted Thoracoscopic Surgery for Lung Nodules. Journal of laparoendoscopic & advanced surgical techniques. Part A 2018. link
5 Torre M, Ferraroli GM, Vanzulli A, Fieschi S. A new safe and stable spiral wire needle for thoracoscopic resection of lung nodules. Chest 2004. link