The value of thoracoscopic ultrasound for the localization of ground-glass opacities with incomplete lung collapse in video-assisted thoracoscopic surgery

Background: Video-assisted thoracoscopic surgery (VATS) has been widely used for the resection of lung lesions. However, it is difficult to palpate or see small lesions, especially ground-glass opacities (GGOs) during VATS. Thoracoscopic ultrasound has definite value in locating pulmonary parenchymal nodules. However, due to the air in the lung parenchyma, its wide application is limited. This study investigated the value of thoracoscopic ultrasound for the localization of GGOs with incomplete lung collapse in VATS.

Methods: A retrospective analysis was conducted on patients diagnosed with ground-glass nodules (GGNs) on computed tomography (CT) at Liaoning Province Tumor Hospital from November 2018 to August 2019, who underwent thoracoscopic ultrasound localization and VATS. Screening was conducted for patients who did not achieve complete collapse of the lungs after natural collapse during surgery, the success rate was calculated, and preoperative CT features and thoracoscopic ultrasound features of GGNs were summarized and analyzed.

Results: The success rate of GGOs' localization by thoracoscopic ultrasound in incomplete collapse lung was 56.67%. Of all preoperative CT features, only the distance between the nodule and the pleura was statistically different (P=0.001). The closer the GGO was to the pleura, the easier it was to be detected.

Conclusions: Thoracoscopic ultrasound could effectively locate GGO in the condition of incomplete lung collapse and not affect the surgical field, especially when the GGO is close to the pleura, which provides an alternative method for GGO localization in patients who cannot achieve complete lung collapse during VATS.