CT-guided percutaneous marking of lung nodules using patent blue V and indocyanine green

Abstract Purpose This short communication aims to provide a technical roadmap for CT-guided dye-based markings of lung nodules in the preoperative management of patients undergoing minimally invasive, robotic-assisted resection. Methods In this single-center retrospective case series, eleven patients with lung nodules were referred to minimally invasive, lung-sparing resection by the multidisciplinary tumor board. CT-guided dye-based markings were performed preoperatively using patent blue V (PBV) and/or indocyanine-green (ICG) injections or ICG-soaked coils. Dyes and coils were placed adjacent to the target lesion, allowing for precise localization during surgery. Technical aspects of the used dye markings are described in detail in the context of available evidence to enable reproducibility. Overall performance metrics for surgical outcomes are reported as intraoperative localization, procedure duration, complication rate, and histological outcome. Results CT-guided dye-based marking and subsequent resections of 12 nodules (median 8.5 mm; IQR 7–10.5 mm) were performed in 11 patients (4 women/7 men; age range 34–77). All procedures were technically successful, with five patients receiving PBV injections (median time 7 min, IQR 5–9.5 min) and six ICG-soaked coil placements (16.5 min, IQR 8–20 min). One asymptomatic pneumothorax occurred during puncture and was managed conservatively. No conversions to open surgery or lobectomy were required due to localization failure. Complete lesion resection was achieved in all cases, revealing seven malignancies. Conclusion CT-guided dye-based markings of lung nodules provide a safe and logistically flexible solution to enhance surgical precision, underscoring the importance of multidisciplinary collaboration and the emerging role of interventional radiology in the perioperative management of these patients.