{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T23:12:04Z","timestamp":1774307524739,"version":"3.50.1"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T00:00:00Z","timestamp":1773100800000},"content-version":"vor","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"University of Campania \u201cL. Vanvitelli\u201d"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Intraoperative ultrasound (Io-US) is used during thoracoscopy to detect lung lesions, but it remains underused during robotic-assisted thoracic surgery (RATS), probably due to the difficulty interpreting US findings. We evaluated whether the use of contrast-enhanced ultrasound (CEUS) could improve the diagnostic accuracy of traditional Io-CEUS for detecting lung nodules during RATS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods<\/jats:title>\n                    <jats:p>It was a retrospective single-centre study including all consecutive patients undergoing RATS for management of small, deeply located lung nodules. In all cases, Io-CEUS was used when Io-US failed to detect lung lesion. The diagnostic accuracy of 2 methods to detect lesions and the inter-group differences regarding operative and perioperative outcomes were statistically evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Our study population included 33 patients. Io-US correctly detected 15 out of 33 lesions (45%) but missed 18 lesions with isoechoic patterns that were corrected identified by Io-CEUS with a significant improvement of diagnostic accuracy (difference 55%; 95% confidence interval: 37.56- 71.53; P\u2009&amp;lt;\u2009.0001). The Io-US group (n\u2009=\u200915) compared to the Io-CEUS group (n\u2009=\u200918) showed no significant differences regarding nodule characteristics such as size (8 mm [7-9] vs 7.8 mm [6-9], P\u2009=\u2009.78); distance from pleura (32 mm [20-44] vs 21 mm [20-42]; P\u2009=\u2009.69); lobe location (lower lobe: 66% vs 61%, P\u2009=\u2009.74); and histological diagnosis (primary lung cancer: 100% vs 88%, P\u2009=\u2009.18).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Io-CEUS is an additional tool for thoracic surgeons to detect lung lesions and could be useful, especially in cases of isoechoic lesions that were poorly defined by traditional Io-US.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejcts\/ezaf434","type":"journal-article","created":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T12:41:20Z","timestamp":1772800880000},"source":"Crossref","is-referenced-by-count":0,"title":["Intraoperative Contrast-Enhanced Ultrasound Versus Traditional Intraoperative Ultrasound for Detecting Lung Nodules During Robotic-assisted Thoracic Surgery"],"prefix":"10.1093","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5129-7201","authenticated-orcid":false,"given":"Gaetana","family":"Messina","sequence":"first","affiliation":[{"name":"Thoracic Surgery Unit, Universita\u0300 degli Studi della Campania \u201cLuigi Vanvitelli\u201d , Napoli, Campania,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Vicario","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Unit, Universita\u0300 degli Studi della Campania \u201cLuigi Vanvitelli\u201d , Napoli, Campania,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincenzo Di","family":"Filippo","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Unit, Universita\u0300 degli Studi della Campania \u201cLuigi Vanvitelli\u201d , Napoli, Campania,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8203-6562","authenticated-orcid":false,"given":"Davide Gerardo","family":"Pica","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Unit, Universita\u0300 degli Studi della Campania \u201cLuigi Vanvitelli\u201d , Napoli, Campania,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5595-6849","authenticated-orcid":false,"given":"Beatrice","family":"Leonardi","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Unit, Universita\u0300 degli Studi della Campania \u201cLuigi Vanvitelli\u201d , Napoli, Campania,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4029-5837","authenticated-orcid":false,"given":"Noemi Maria","family":"Giorgiano","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Unit, Universita\u0300 degli Studi della Campania \u201cLuigi Vanvitelli\u201d , Napoli, Campania,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela","family":"Iovine","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Unit, Universita\u0300 degli Studi della Campania \u201cLuigi Vanvitelli\u201d , Napoli, Campania,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riccardo","family":"Vinciguerra","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Unit, Universita\u0300 degli Studi della Campania \u201cLuigi Vanvitelli\u201d , Napoli, Campania,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Capasso","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Unit, Universita\u0300 degli Studi della Campania \u201cLuigi Vanvitelli\u201d , Napoli, Campania,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Chiodini","sequence":"additional","affiliation":[{"name":"Medical Statistics Unit, Universita\u0300 degli Studi della Campania \u201cLuigi Vanvitelli\u201d , Napoli, Campania,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annafrancesca","family":"Smimmo","sequence":"additional","affiliation":[{"name":"Medical Statistics Unit, Universita\u0300 degli Studi della Campania \u201cLuigi Vanvitelli\u201d , Napoli, Campania,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Vicidomini","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Unit, Universita\u0300 degli Studi della Campania \u201cLuigi Vanvitelli\u201d , Napoli, Campania,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0628-613X","authenticated-orcid":false,"given":"Alfonso","family":"Fiorelli","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Unit, Universita\u0300 degli Studi della Campania \u201cLuigi Vanvitelli\u201d , Napoli, Campania,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,3,9]]},"reference":[{"key":"2026032318124763500_ezaf434-B1","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1001\/jama.2021.24287","article-title":"Evaluating the patient with a pulmonary nodule: a review","volume":"327","author":"Mazzone","year":"2022","journal-title":"JAMA"},{"key":"2026032318124763500_ezaf434-B2","doi-asserted-by":"crossref","first-page":"5271","DOI":"10.21037\/qims-22-309","article-title":"Intraoperative identification of pulmonary nodules during minimally invasive thoracic surgery: a narrative review","volume":"12","author":"Tang","year":"2022","journal-title":"Quant Imaging Med Surg"},{"key":"2026032318124763500_ezaf434-B3","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1016\/j.jtcvs.2012.08.034","article-title":"Thoracoscopic localization of intraparenchymal pulmonary nodules using direct intracavitary thoracoscopic ultrasonography prevents conversion of VATS procedures to thoracotomy in selected patients","volume":"144","author":"Khereba","year":"2012","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026032318124763500_ezaf434-B4","doi-asserted-by":"crossref","first-page":"1354","DOI":"10.1111\/1759-7714.13384","article-title":"Ultrasound location of pulmonary nodules in video-assisted thoracoscopic surgery for precise sublobectomy","volume":"11","author":"Hou","year":"2020","journal-title":"Thorac Cancer"},{"key":"2026032318124763500_ezaf434-B5","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1016\/j.athoracsur.2011.03.030","article-title":"Ultrasonographic identification of peripheral pulmonary nodules through uniportal video-assisted thoracic surgery","volume":"92","author":"Rocco","year":"2011","journal-title":"Ann Thorac Surg"},{"key":"2026032318124763500_ezaf434-B6","doi-asserted-by":"publisher","first-page":"2558","DOI":"10.1111\/1759-7714.15027","article-title":"Intraoperative lung ultrasound improves subcentimetric pulmonary nodule localization during VATS: results of a retrospective analysis","volume":"14","author":"Gambardella","year":"2023","journal-title":"Thorac Cancer"},{"key":"2026032318124763500_ezaf434-B7","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1093\/icvts\/ivx373","article-title":"The use of ultrasound in detecting and defining ground-glass opacities: results of an ex vivo evaluation","volume":"26","author":"Fiorelli","year":"2018","journal-title":"Interact CardioVasc Thorac Surg"},{"key":"2026032318124763500_ezaf434-B8","first-page":"1191","article-title":"Intraoperative lung ultrasound (ILU) for the assessment of pulmonary nodules","volume":"11","author":"Taurchini","year":"2021","journal-title":"Diagnostics (Basel)"},{"key":"2026032318124763500_ezaf434-B9","doi-asserted-by":"crossref","first-page":"374","DOI":"10.11152\/mu-1053","article-title":"An \u201calternative finger\u201d in robotic-assisted thoracic surgery: intraoperative ultrasound localization of pulmonary nodules","volume":"19","author":"Zhou","year":"2017","journal-title":"Med Ultrason"},{"key":"2026032318124763500_ezaf434-B10","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.xjtc.2025.01.028","article-title":"Lung nodule detection by intraoperative ultrasound during robotic surgery","volume":"30","author":"Fiorelli","year":"2025","journal-title":"JTCVS Tech"},{"key":"2026032318124763500_ezaf434-B11","first-page":"7S","volume-title":"Chest","author":"Detterbeck","year":"2013"},{"key":"2026032318124763500_ezaf434-B12","doi-asserted-by":"crossref","first-page":"106907","DOI":"10.1016\/j.ejso.2023.04.006","article-title":"Lung cancer resection in the absence of pre-operative histology: the Accuracy of Multidisciplinary Team Consensus","volume":"49","author":"Whooley","year":"2023","journal-title":"Eur J Surg Oncol"},{"key":"2026032318124763500_ezaf434-B13","doi-asserted-by":"crossref","first-page":"3389","DOI":"10.1111\/1759-7714.15131","article-title":"Three-dimensional lung reconstructions for the localization of lung nodules to be resected during surgery","volume":"14","author":"Natale","year":"2023","journal-title":"Thorac Cancer"},{"key":"2026032318124763500_ezaf434-B14","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1055\/s-0040-1708836","article-title":"Methylene blue versus coil-based computed tomography-guided localization of lung nodules","volume":"68","author":"Zhang","year":"2020","journal-title":"Thorac Cardiovasc Surg"},{"key":"2026032318124763500_ezaf434-B15","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1186\/s13019-020-01279-9","article-title":"CT-guided hook-wire localization of malignant pulmonary nodules for video assisted thoracoscopic surgery","volume":"15","author":"Zhang","year":"2020","journal-title":"J Cardiothorac Surg"},{"key":"2026032318124763500_ezaf434-B16","doi-asserted-by":"crossref","first-page":"2113","DOI":"10.1016\/j.jtcvs.2017.08.065","article-title":"Three-dimensional printing of navigational template in localization of pulmonary nodule: a pilot study","volume":"154","author":"Zhang","year":"2017","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026032318124763500_ezaf434-B17","doi-asserted-by":"crossref","first-page":"e230171","DOI":"10.1148\/rg.230171","article-title":"Conventional and contrast-enhanced US of the lung: from performance to diagnosis","volume":"44","author":"Jim\u00e9nez-Serrano","year":"2024","journal-title":"Radiographics"},{"key":"2026032318124763500_ezaf434-B18","first-page":"231782","article-title":"The role of contrast-enhanced ultrasound in selection indication and improveing diagnosis for transthoracic biopsy in peripheral pulmonary and mediastinal lesions","volume":"2015","author":"Wang","year":"2015","journal-title":"Biomed Res Int"},{"key":"2026032318124763500_ezaf434-B19","first-page":"31","article-title":"Contrastenhanced ultrasound (CEUS) and CEUS-guided biopsy in the diagnosis of lung abscess in a patient with achalasia: case report","volume":"5","author":"di Vece","year":"2013","journal-title":"Interv Med Appl Sci"},{"key":"2026032318124763500_ezaf434-B20","doi-asserted-by":"crossref","first-page":"3854","DOI":"10.3390\/cancers15153854","article-title":"Intraoperative contrast-enhanced ultrasonography (Io-CEUS) in minimally invasive thoracic surgery for characterization of pulmonary tumours: a clinical feasibility study","volume":"15","author":"Schauer","year":"2023","journal-title":"Cancers (Basel)"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ejcts\/advance-article-pdf\/doi\/10.1093\/ejcts\/ezaf434\/67282373\/ezaf434.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/68\/3\/ezaf434\/67282373\/ezaf434.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/68\/3\/ezaf434\/67282373\/ezaf434.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T22:12:53Z","timestamp":1774303973000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/doi\/10.1093\/ejcts\/ezaf434\/8512505"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":20,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3,10]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezaf434","relation":{},"ISSN":["1010-7940","1873-734X"],"issn-type":[{"value":"1010-7940","type":"print"},{"value":"1873-734X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,3]]},"published":{"date-parts":[[2026,3]]},"article-number":"ezaf434"}}