Preoperative CT-guided Fiducial Marker Placement for Surgical Localization of Pulmonary Nodules

Abstract

Purpose: To assess the technical success and complication rates of CT-guided fiducial marker placement for the localization of pulmonary nodules and to assess the surgical localization failure rate. Materials and Methods: This was a single-center, retrospective analysis of consecutive patients who underwent CT-guided fiducial marker placement procedures between 2014 and 2020. End points included the technical success of the fiducial marker placement, procedural complications, and the surgical localization failure rate. A two-sample t test and a Fisher exact test were used to compare continuous and categorical variables, respectively. Multivariate logistic regression was used to identify independent risk factors for complications. Results: A total of 198 preoperative CT-guided fiducial marker placement procedures were performed in 190 patients (mean age, 64 years 6 12 [standard deviation]; 121 women) to localize 205 nodules (mean size, 10 mm 6 4; mean distance to the pleura, 10 mm 6 9). The technical success rate was 98.5% (195 of 198). There were no major complications. A total of 202 nodules were resected during 193 procedures performed 5 days 6 13 after the fiducial marker placement (range, 0–123 days). Surgical localization failure occurred in one patient (0.5%). Of the resected nodules, 146 were lung cancers, 26 nodules were metastases, two were carcinoid tumors, and 28 were benign. Conclusion: The CT-guided fiducial marker placement of pulmonary nodules was safe, effective, and resulted in a low surgical localization failure rate.