• Samy Lachkar, Florian Guisier, Maxime Roger, Bérengère Obstoy, Suzanna Bota, Delphine Lerouge, Nicolas Piton, Luc Thiberville, and Mathieu Salaün.
• Department of Pulmonology, Thoracic Oncology, and Respiratory Intensive Care and CIC-CRB 1404, Rouen, France.
• Chest. 2018 Feb 1; 153 (2): 387-394.

BackgroundStereotactic radiotherapy is used to treat peripheral lung cancer in inoperable patients. Placement of fiducial gold markers (FMs) is crucial for tracking small lesions that are not visible on chest radiographs. Our objective was to assess endoscopic FM placement in small peripheral lung nodules (PLNs) that are not trackable using automated tracking software.MethodsAll patients benefiting from virtual bronchoscopy and radial endobronchial ultrasonography (R-EBUS)-guided placement of FMs for PLNs < 20 mm were included. After confirmation by biopsy sampling, a gold-seed FM was inserted into the nodule using a bronchial brush, without the use of fluoroscopy. The performance and complications of the procedure were recorded.ResultsFrom May 2010 to June 2015, FMs were placed in the PLNs of 54 consecutive patients, 34 of whom presented with a nodule < 20 mm. Seventy-six percent of the procedures were performed using local anesthesia on an outpatient basis. The median long- and short-axis diameters of nodules were 15 mm (9-20 mm) and 11 mm (6-20 mm), respectively, with 31 of 34 nodules exhibiting a short axis of < 15 mm. In 23 cases (79%), histologic samples were obtained during the procedure that allowed FM placement. Migration occurred in six cases, including two in the hours following the procedure. FMs were in place and visible on CT imaging performed 3 months after radiation therapy in 80% of cases. No complications were reported.ConclusionsDiagnosis of peripheral nodules < 20 mm and FM placement using R-EBUS are efficient and safe in a single procedure.Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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