{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:28:37Z","timestamp":1773275317914,"version":"3.50.1"},"reference-count":33,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2022,3,9]],"date-time":"2022-03-09T00:00:00Z","timestamp":1646784000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010425","name":"Tri-Service General Hospital","doi-asserted-by":"publisher","award":["TSGH-D-110082; TSGH-D-111067"],"award-info":[{"award-number":["TSGH-D-110082; TSGH-D-111067"]}],"id":[{"id":"10.13039\/501100010425","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Clinically, a major challenge of multiple nodule localization is puncture-related pneumothorax, which may hamper the successful localization. This study aims to investigate and compare the efficacy and safety of the simultaneous and sequential patent blue dye (PBD) injections for identifying multiple pulmonary nodules during preoperative CT-guided localization. Materials and Methods: Sixty-one consecutive patients with multiple pulmonary nodules who underwent preoperative CT-guided localization with PBD injections between January 2020 and December 2020 were retrospectively enrolled. Of these patients, 31 patients with 64 nodules who underwent simultaneous injections were designated as the simultaneous group; the remaining 30 patients with 63 nodules who underwent sequential punctures were designated as the sequential group. The clinical and radiological features, technical information, pathological results, and procedure-related variables and complications of the two groups were reviewed and analyzed. Results: The localization success rate of the simultaneous group was higher than that of the sequential group (100% [64\/64] vs. 93.7% [59\/63], p = 0.041). The incidences of pneumothorax (32.3 vs. 33.3%, p = 0.929) and pulmonary hemorrhage (6.3 vs. 3.0%, p = 1) were not significantly different between the two groups, and all cases were minor, which did not require further intervention. Additionally, a significantly lower radiation dose (2.7 vs. 3.5 mSv, p = 0.001) and a shorter procedure time (20.95 vs. 25.28 min, p = 0.001) were observed in the simultaneous group than in the sequential group. Conclusions: Compared with the sequential method, simultaneous PBD injections may improve the localization success rate with a shorter procedure time and less radiation exposure if the patient with multiple pulmonary nodules can be approached in a single position. Further prospective studies are needed to validate these results.<\/jats:p>","DOI":"10.3390\/medicina58030405","type":"journal-article","created":{"date-parts":[[2022,3,9]],"date-time":"2022-03-09T01:53:54Z","timestamp":1646790834000},"page":"405","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Simultaneous Patent Blue Dye Injections Aid in the Preoperative CT-Guided Localization of Multiple Pulmonary Nodules"],"prefix":"10.3390","volume":"58","author":[{"given":"Ya-Che","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tsai-Wang","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hsian-He","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei-Chou","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kai-Hsiung","family":"Ko","sequence":"additional","affiliation":[{"name":"Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"100","DOI":"10.3322\/caac.21392","article-title":"Cancer screening in the United States, 2017: A review of current American Cancer Society guidelines and current issues in cancer screening","volume":"67","author":"Smith","year":"2017","journal-title":"CA Cancer J. Clin."},{"key":"ref_3","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. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.lungcan.2017.08.023","article-title":"Relationship between nodule count and lung cancer probability in baseline CT lung cancer screening: The NELSON study","volume":"113","author":"Heuvelmans","year":"2017","journal-title":"Lung Cancer"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1852","DOI":"10.1007\/s00464-007-9720-z","article-title":"Video-assisted thoracic surgery (VATS) lobectomy: 13 years\u2019 experience","volume":"22","author":"Congregado","year":"2008","journal-title":"Surg. Endosc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1378\/chest.115.2.563","article-title":"Video-assisted thoracoscopic surgery for small indeterminate pulmonary nodules: Indications for preoperative marking","volume":"115","author":"Suzuki","year":"1999","journal-title":"Chest"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"28","DOI":"10.21037\/atm.2019.01.27","article-title":"Safety and efficacy of computed tomography-guided dye localization using patent blue V for single lung nodule for video-assisted thoracoscopic surgery: A retrospective study","volume":"7","author":"Chen","year":"2019","journal-title":"Ann. Transl. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/j.jtcvs.2016.04.052","article-title":"Computed tomography-guided patent blue vital dye localization of pulmonary nodules in uniportal thoracoscopy","volume":"152","author":"Lin","year":"2016","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1264","DOI":"10.1148\/rg.2019180183","article-title":"Image-guided preoperative localization of pulmonary nodules for video-assisted and robotically assisted surgery","volume":"39","author":"McDermott","year":"2019","journal-title":"Radiographics"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Xu, Y., Ma, L., Sun, H., Huang, Z., Zhang, Z., Xiao, F., Ma, Q., Lin, J., and Xie, S. (2021). The utility of simultaneous CT-guided localization for multiple pulmonary nodules using microcoil before video-assisted thoracic surgery. BMC Pulm. Med., 21.","DOI":"10.1186\/s12890-021-01393-x"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"6539","DOI":"10.1007\/s00330-021-07772-6","article-title":"Simultaneous preoperative computed tomography-guided microcoil localizations of multiple pulmonary nodules","volume":"31","author":"Hu","year":"2021","journal-title":"Eur. Radiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"661956","DOI":"10.3389\/fmed.2021.661956","article-title":"Computed tomography-guided methylene blue localization: Single vs. multiple lung nodules","volume":"8","author":"Lin","year":"2021","journal-title":"Front. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1753466620909762","DOI":"10.1177\/1753466620909762","article-title":"Preoperative computed tomography-guided coil localization for multiple lung nodules","volume":"14","author":"Teng","year":"2020","journal-title":"Ther. Adv. Respir. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"S666","DOI":"10.21037\/jtd.2016.09.46","article-title":"Preoperative computed tomography-guided dye injection to localize multiple lung nodules for video-assisted thoracoscopic surgery","volume":"8","author":"Tseng","year":"2016","journal-title":"J. Thorac. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.clinimag.2019.06.015","article-title":"A simple and efficient method to perform preoperative pulmonary nodule localization: CT-guided patent blue dye injection","volume":"58","author":"Ko","year":"2019","journal-title":"Clin. Imaging"},{"key":"ref_16","first-page":"488","article-title":"Preoperative versus intraoperative image-guided localization of multiple ipsilateral lung nodules","volume":"57","author":"Chao","year":"2020","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"McCollough, C., Edyvean, S., Geise, R., Gould, B., Keat, N., Huda, W., Judy, P., Kalender, W., McNitt-Gray, M., and Morin, R. (2008). The Measurement, Reporting, and Management of Radiation Dose in CT, American Association of Physicists in Medicine.","DOI":"10.37206\/97"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1148\/radiol.2015150381","article-title":"Frequency and severity of pulmonary hemorrhage in patients undergoing percutaneous CT-guided transthoracic lung biopsy: Single-institution experience of 1175 cases","volume":"279","author":"Tai","year":"2016","journal-title":"Radiology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"66","DOI":"10.21037\/jovs.2017.03.22","article-title":"Thoracoscopic wedge resection and segmentectomy for small-sized pulmonary nodules","volume":"3","author":"Kato","year":"2017","journal-title":"J. Vis. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1408","DOI":"10.1007\/s00270-017-1631-3","article-title":"Retrospective evaluation of safety, efficacy and risk factors for pneumothorax in simultaneous localizations of multiple pulmonary nodules using hook wire system","volume":"40","author":"Zhong","year":"2017","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s13019-019-0870-6","article-title":"Computed tomography-guided simultaneous coil localization as a bridge to one-stage surgery for multiple lung nodules: A retrospective study","volume":"14","author":"Fu","year":"2019","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1080\/13645706.2020.1725579","article-title":"Computed tomography-guided localization for lung nodules: Methylene-blue versus coil localization","volume":"30","author":"Sun","year":"2021","journal-title":"Minim. Invasive Ther. Allied Technol."},{"key":"ref_23","first-page":"S99","article-title":"Pneumothorax after transthoracic needle biopsy of lung lesions under CT guidance","volume":"6","author":"Boskovic","year":"2014","journal-title":"J. Thorac. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1148\/radiology.219.1.r01ap11247","article-title":"Transthoracic needle biopsy of the lung: Results of early discharge in 506 outpatients","volume":"219","author":"Dennie","year":"2001","journal-title":"Radiology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"778","DOI":"10.2214\/AJR.19.21175","article-title":"Intraoperative percutaneous microcoil localization of small peripheral pulmonary nodules using cone-beam CT in a hybrid operating room","volume":"213","author":"Lempel","year":"2019","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"S681","DOI":"10.21037\/jtd.2016.09.55","article-title":"Image-guided thoracoscopic surgery with dye localization in a hybrid operating room","volume":"8","author":"Yang","year":"2016","journal-title":"J. Thorac. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1974","DOI":"10.1016\/j.jtcvs.2018.06.088","article-title":"A comparison of efficacy and safety of preoperative versus intraoperative computed tomography-guided thoracoscopic lung resection","volume":"156","author":"Chao","year":"2018","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.1016\/j.athoracsur.2018.07.030","article-title":"Preoperative dye localization for thoracoscopic lung surgery: Hybrid versus computed tomography room","volume":"106","author":"Chen","year":"2018","journal-title":"Ann. Thorac. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1093\/ejcts\/ezx309","article-title":"Single-stage localization and removal of small lung nodules through image-guided video-assisted thoracoscopic surgery","volume":"53","author":"Hsieh","year":"2018","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"297","DOI":"10.2214\/ajr.163.2.7518642","article-title":"Localization of pulmonary nodules before thoracoscopic surgery: Value of percutaneous staining with methylene blue","volume":"163","author":"Lenglinger","year":"1994","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1986","DOI":"10.1016\/j.jtcvs.2018.03.152","article-title":"Radiotracer localization of nonpalpable pulmonary nodules: A single-center experience","volume":"156","author":"Starnes","year":"2018","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1016\/S0003-4975(00)02505-4","article-title":"Thoracoscopic resection of pulmonary nodules after computed tomographic-guided coil labeling","volume":"71","author":"Lizza","year":"2001","journal-title":"Ann. Thorac. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1177\/0284185113506136","article-title":"Novel CT-guided coil localization of peripheral pulmonary nodules prior to video-assisted thoracoscopic surgery: A pilot study","volume":"55","author":"Liu","year":"2014","journal-title":"Acta Radiol."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/3\/405\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:33:23Z","timestamp":1760135603000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/3\/405"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,9]]},"references-count":33,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,3]]}},"alternative-id":["medicina58030405"],"URL":"https:\/\/doi.org\/10.3390\/medicina58030405","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,9]]}}}