Accuracy and application of noninvasive computed tomography-guided skin marking in surgery for peripheral small pulmonary nodules.

OBJECTIVE

Intraoperative localization of small peripheral pulmonary nodules can be challenging due to the size, characteristics, or depth of nodules. This study introduced a computed tomography (CT)-guided skin marking method and evaluated its feasibility and accuracy.

METHODS

From January 2017 to January 2026, 89 patients underwent CT-guided skin marking followed by wedge lung resection. Eligible nodules were located in the outer third of the lung and measured ≤ 1 cm in diameter or ≤ 2 cm in maximum diameter, with a consolidation-to-tumor ratio of ≤ 0.25 were considered eligible. CT-guided skin marking was performed a day before surgery. During the operation, a port was created at the marked skin site, and a dyed cotton swab was used to mark the visceral pleura. Wedge resection was conducted using the pigmented mark as a guide. Distance from the marker to the visceral pleural surface directly above the lesion (hereinafter referred to as distance) was measured, and factors associated with a value of ≥ 10 mm were identified using logistic regression analysis.

RESULTS

All nodules were completely resected without complications. The median distance was 6 (range: 0-25) mm. A greater chest wall thickness and a larger port insertion angle were significantly associated with distance of ≥10 mm.

CONCLUSIONS

CT-guided skin marking is a simple and safe technique and does not require special equipment. Notably, distance increases in cases involving thick chest walls or large port insertion angles. Hence, this method can be a reliable and widely applicable approach for the accurate resection of small peripheral pulmonary nodules.