{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:34:22Z","timestamp":1760060062152,"version":"build-2065373602"},"reference-count":26,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T00:00:00Z","timestamp":1753747200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: The extensive use of computed tomography (CT) has led to a significant increase in the detection of small and non-palpable pulmonary nodules, necessitating the use of invasive methods for definitive diagnosis. Video-assisted thoracoscopic surgery (VATS) has become the preferred procedure for nodule resections; however, intraoperative localization remains challenging, especially for deep or subsolid lesions. This study explores whether SPECT\/CT improves the technical and clinical outcomes of radio-guided occult lesion localization (ROLL) before uniportal video-assisted thoracoscopic surgery (u-VATS). Methods: This is a retrospective study involving consecutive patients referred for the resection of pulmonary nodules who underwent CT-guided ROLL followed by u-VATS between September 2017 and December 2024. From January 2023, SPECT\/CT was systematically added after planar imaging. The cohort was divided into a planar group and a planar + SPECT\/CT group. The inclusion criteria involved nodules sized \u2264 2 cm, with ground glass or solid characteristics, located at a depth of &lt;6 cm from the pleural surface. 99mTc-MAA injected activity, timing, the classification of planar and SPECT\/CT image findings (focal uptake, multisite with focal uptake, multisite without focal uptake), spillage, and post-procedure complications were evaluated. Statistical analysis was performed, with continuous data expressed as the median and categorical data as the number. Comparisons were made using chi-square tests for categorical variables and the Mann\u2013Whitney U test for procedural duration. Cohen\u2019s kappa coefficient was calculated to assess agreement between imaging modalities. Results: In total, 125 patients were selected for CT-guided radiotracer injection followed by uniportal-VATS. The planar group and planar + SPECT\/CT group comprised 60 and 65 patients, respectively. Focal uptake was detected in 68 (54%), multisite with focal uptake in 46 (36.8%), and multisite without focal uptake in 11 patients (8.8%). In comparative analyses between planar and SPECT\/CT imaging in 65 patients, 91% exhibited focal uptake, revealing significant differences in classification for 40% of the patients. SPECT\/CT corrected the classification of 23 patients initially categorized as multisite with focal uptake to focal uptake, improving localization accuracy. The mean procedure duration was 39 min with SPECT\/CT. Pneumothorax was more frequently detected with SPECT\/CT (43% vs. 1.6%). The intraoperative localization success rate was 96%. Conclusions: SPECT\/CT imaging in the ROLL procedure for detecting pulmonary nodules before u-VATs demonstrates a significant advantage in reclassifying radiotracer positioning compared to planar imaging. Considering its limited impact on surgical success rates and additional procedural time, SPECT\/CT should be reserved for technically challenging cases. Larger sample sizes, multicentric and prospective randomized studies, and formal cost\u2013utility analyses are warranted.<\/jats:p>","DOI":"10.3390\/jcm14155337","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T08:00:41Z","timestamp":1753776041000},"page":"5337","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Added Value of SPECT\/CT in Radio-Guided Occult Localization (ROLL) of Non-Palpable Pulmonary Nodules Treated with Uniportal Video-Assisted Thoracoscopy"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5798-9943","authenticated-orcid":false,"given":"Demetrio","family":"Aric\u00f2","sequence":"first","affiliation":[{"name":"Nuclear Medicine Unit, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucia","family":"Motta","sequence":"additional","affiliation":[{"name":"Medical Oncology Unit, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy"},{"name":"Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9608-2065","authenticated-orcid":false,"given":"Giulia","family":"Giacoppo","sequence":"additional","affiliation":[{"name":"Nuclear Medicine Unit, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelangelo","family":"Bambaci","sequence":"additional","affiliation":[{"name":"Nuclear Medicine Unit, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6410-8980","authenticated-orcid":false,"given":"Paolo","family":"Macr\u00ec","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Unit, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefania","family":"Maria","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Unit, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8542-0904","authenticated-orcid":false,"given":"Francesco","family":"Barbagallo","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Unit, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9724-1846","authenticated-orcid":false,"given":"Nicola","family":"Ricottone","sequence":"additional","affiliation":[{"name":"Radiotherapy Unit, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorenza","family":"Marino","sequence":"additional","affiliation":[{"name":"Radiotherapy Unit, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gianmarco","family":"Motta","sequence":"additional","affiliation":[{"name":"Medical Oncology Unit, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy"},{"name":"Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giorgia","family":"Leone","sequence":"additional","affiliation":[{"name":"Pathology Section, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlo","family":"Carnaghi","sequence":"additional","affiliation":[{"name":"Medical Oncology Unit, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8406-9416","authenticated-orcid":false,"given":"Vittorio","family":"Gebbia","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Surgery, \u201cKore\u201d University of Enna, 94100 Enna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Domenica","family":"Caponnetto","sequence":"additional","affiliation":[{"name":"Data Manager Unit, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5955-9488","authenticated-orcid":false,"given":"Laura","family":"Evangelista","sequence":"additional","affiliation":[{"name":"Department of Biomedical Science, Humanitas University, 20089 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1016\/S0140-6736(22)01694-4","article-title":"Lung Cancer Screening","volume":"401","author":"Adams","year":"2023","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1056\/NEJMoa1911793","article-title":"Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial","volume":"382","author":"Scholten","year":"2020","journal-title":"N. 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